Provider Demographics
NPI:1730744806
Name:NIEVES QUINONES, DAVIS M
Entity type:Individual
Prefix:
First Name:DAVIS
Middle Name:M
Last Name:NIEVES QUINONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 FREE FALL AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-1430
Mailing Address - Country:US
Mailing Address - Phone:702-528-6958
Mailing Address - Fax:
Practice Address - Street 1:368 FREE FALL AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-1430
Practice Address - Country:US
Practice Address - Phone:702-528-6958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-04
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health