Provider Demographics
NPI:1285526079
Name:ROSARIO NIEVES, ILIA CRISTINA (PHD)
Entity type:Individual
Prefix:
First Name:ILIA
Middle Name:CRISTINA
Last Name:ROSARIO NIEVES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8802
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-8802
Mailing Address - Country:US
Mailing Address - Phone:787-436-0942
Mailing Address - Fax:
Practice Address - Street 1:1501 AVE LAS BRISAS APT 202
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-5223
Practice Address - Country:US
Practice Address - Phone:787-436-0942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3468103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist