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NPI Code Detail

MEDICARE: DR. BONIFACIO RIVERA-VIRELLA DMD

MEDICARE: DR. BONIFACIO RIVERA-VIRELLA DMD
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
11223S0112XOral and Maxillofacial Surgery (Dentist)1370PR

General Provider Information

NPI Number : 1396738571
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BONIFACIO RIVERA-VIRELLA DMD
Provider Business Mailing Address
First Line : CIRUGIA ORAL Y MAXILOFACIAL RCM
Second Line : PO BOX 29134
City : SAN JUAN
State : PR
Zip : 00929-0134
Country : US
Telephone Number : 787-758-2525
Fax Number : 787-751-0858
Provider Business Practice Location Address
First Line : CLINICAS EXTERNAS ASEM - CIRUGIA ORAL Y MAXILOFACIAL
Second Line : CENTRO MEDICO DE PR, BO. MONACILLOS
City : RIO PIEDRAS
State : PR
Zip : 00935
Country : US
Telephone Number : 787-777-3535
Fax Number : 787-751-0858
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2005
Last Update Date : 05/19/2021

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