MEDICARE: VITALIFERA LLC

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1821926429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITALIFERA LLC

Provider Business Mailing Address
First Line	:	PO BOX 7757
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00732-7757
Country	:	US
Telephone Number	:	787-600-1138
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 AVENIDA EDUARDO RUBERTE
Second Line	:	OFICINA 101
City	:	PONCE
State	:	PR
Zip	:	00728-1739
Country	:	US
Telephone Number	:	787-259-5990
Fax Number	:

Authorized Official
Title or Position	:	OWNER / MANAGING MEMBER
Name	:	DR. MIRIAM RIVERA MENDOZA
Credential	:	MD
Telephone Number	:	787-600-1138

Provider Enumeration Date	:	05/12/2026
Last Update Date	:	05/12/2026

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Directions to “VITALIFERA LLC ” Practice Location

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