Basic Information
| Provider Information | |||||||||
| NPI: | 1417188319 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NIEVES | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | NOEL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2315 W MURPHY DR | ||||||||
| Address2: | |||||||||
| City: | DUNLAP | ||||||||
| State: | IL | ||||||||
| PostalCode: | 615259445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2016812569 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10300 SW 216TH ST | ||||||||
| Address2: | |||||||||
| City: | CUTLER BAY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052535100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2009 | ||||||||
| LastUpdateDate: | 07/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 18570 | PR | N | Allopathic & Osteopathic Physicians | General Practice | 2084P0800X | ME130572 | FL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 02249550 | 05 | FL | MEDICAID | JE608Z | 05 | FL | MEDICAID |