1740379767 NPI number — DR. EVELYN RIVERA M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740379767 NPI number — DR. EVELYN RIVERA M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

RIVERA

Provider First Name:

EVELYN

Provider Middle Name:

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

F

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:

1740379767

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/08/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

563 CALLE ARRIGOITIA

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SAN JUAN

Provider Business Mailing Address State Name:

PR

Provider Business Mailing Address Postal Code:

00918-3726

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

787-714-0125

Provider Business Mailing Address Fax Number:

787-756-8471

Provider First Line Business Practice Location Address:

CARR 172 KM3.3 AVE EL JIBARO

Provider Second Line Business Practice Location Address:

CENTRO DE SALUD FAMILIAR MENONITA OFICINA 104

Provider Business Practice Location Address City Name:

CIDRA

Provider Business Practice Location Address State Name:

PR

Provider Business Practice Location Address Postal Code:

00739

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

787-714-0125

Provider Business Practice Location Address Fax Number:

787-714-0125

Provider Enumeration Date:

10/11/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208000000X , with the licence number:  09202 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: HUMANAHEALTHPLANSPR . This is a "9180428" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: HUMANAINSURANCEPRINC . This is a "9180428" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: LACRUZAZULDEPR . This is a "060695" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: MEDICALCARDSISTEMINC . This is a "2-9202" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: ASOCIACIONDEMAESTRO . This is a "3581-5" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: GLOBALHEALTHPLAN&INS . This is a "129-9202PE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: MENONITA . This is a "M00080" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: PREFERREDHEALTH . This is a "203708" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: TRIPLE-S . This is a "2-1761" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
• Identifier: AMERICANHEALTH,INC. . This is a "1525" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".