1942500954 NPI number — DR. ALICIA GUILLOTY RIVERA MD

Table of content: DR. ALICIA GUILLOTY RIVERA MD (NPI 1942500954)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942500954 NPI number — DR. ALICIA GUILLOTY RIVERA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUILLOTY RIVERA
Provider First Name:
ALICIA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1942500954
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 143195
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARECIBO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00614-3195
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-933-3392
Provider Business Mailing Address Fax Number:
787-650-8257

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PR- 129 KM 9.2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HATILLO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00659-9798
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-672-1835
Provider Business Practice Location Address Fax Number:
787-650-8257
Provider Enumeration Date:
10/25/2010

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: 208D00000X , with the licence number:  18011 , 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)

  • Identifier: 18011 . This is a "THE PUERTO RICO BOARD OF LICENSING AND MEDICAL DISCIPLINES" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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