MEDICARE: DR. AILEEN RIVERA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	14390	PR

General Provider Information

NPI Number	:	1336108331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AILEEN RIVERA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 11913
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00922-1913
Country	:	US
Telephone Number	:	787-999-0753
Fax Number	:	787-841-7228

Provider Business Practice Location Address
First Line	:	917 AVE TITO CASTRO
Second Line	:	HOSPITAL EPISCOPAL SAN LUCAS
City	:	PONCE
State	:	PR
Zip	:	00733
Country	:	US
Telephone Number	:	787-844-2080
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	01/16/2019

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