Provider Demographics
NPI:1447961289
Name:VIERA, NELSON IVAN (PHD)
Entity type:Individual
Prefix:DR
First Name:NELSON
Middle Name:IVAN
Last Name:VIERA
Suffix:
Gender:M
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:EXT JARDINES DE COAMO
Mailing Address - Street 2:13 STREET F-21
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769
Mailing Address - Country:US
Mailing Address - Phone:939-441-3778
Mailing Address - Fax:
Practice Address - Street 1:EXT JARDINES DE COAMO
Practice Address - Street 2:13 STREET F-21
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769
Practice Address - Country:US
Practice Address - Phone:939-441-3778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-13
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7650103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical