MEDICARE: NATIVIDAD RODRIGUEZ RIVERA MD

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	2084P0800X	Psychiatry Physician	4893	PR

General Provider Information

NPI Number	:	1669556395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATIVIDAD RODRIGUEZ RIVERA MD

Provider Business Mailing Address
First Line	:	PO BOX 366294
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00936-6294
Country	:	US
Telephone Number	:	787-751-5955
Fax Number	:	787-767-0516

Provider Business Practice Location Address
First Line	:	LODI STREET A2
Second Line	:	VILLA LUARCA
City	:	SAN JUAN
State	:	PR
Zip	:	00924-0000
Country	:	US
Telephone Number	:	787-751-5955
Fax Number	:	787-767-0516

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	07/08/2007

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