Healthcare Provider Details

I. General information

NPI: 1881519635
Provider Name (Legal Business Name): SAIDA AZUCENA RIVERA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 KEY PKWY STE 102
FREDERICK MD
21702-4496
US

IV. Provider business mailing address

7103 ROCK CREEK DR
FREDERICK MD
21702-3645
US

V. Phone/Fax

Practice location:
  • Phone: 240-215-1138
  • Fax:
Mailing address:
  • Phone: 240-409-7686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR242030
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: