Provider Demographics
NPI:1861514119
Name:NIEVES VARGAS, CARMEN ALICIA
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:ALICIA
Last Name:NIEVES VARGAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 3 BOX 6662
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-883-3309
Mailing Address - Fax:
Practice Address - Street 1:CARR NO 2 KM 29 6
Practice Address - Street 2:
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692-0330
Practice Address - Country:US
Practice Address - Phone:787-883-4445
Practice Address - Fax:787-883-7538
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1955183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist