1396738571 NPI number — DR. BONIFACIO RIVERA-VIRELLA DMD

Table of content: DR. BONIFACIO RIVERA-VIRELLA DMD (NPI 1396738571)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396738571 NPI number — DR. BONIFACIO RIVERA-VIRELLA DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVERA-VIRELLA
Provider First Name:
BONIFACIO
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396738571
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CIRUGIA ORAL Y MAXILOFACIAL RCM
Provider Second Line Business Mailing Address:
PO BOX 29134
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00929-0134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-758-2525
Provider Business Mailing Address Fax Number:
787-751-0858

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CLINICAS EXTERNAS ASEM - CIRUGIA ORAL Y MAXILOFACIAL
Provider Second Line Business Practice Location Address:
CENTRO MEDICO DE PR, BO. MONACILLOS
Provider Business Practice Location Address City Name:
RIO PIEDRAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-777-3535
Provider Business Practice Location Address Fax Number:
787-751-0858
Provider Enumeration Date:
08/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  1370 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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