Healthcare Provider Details

I. General information

NPI: 1164029286
Provider Name (Legal Business Name): PAULA M RIVERA MILLAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 SEAVIEW AVE
STATEN ISLAND NY
10305-3436
US

IV. Provider business mailing address

URB. MANSIONES CALLE 4 E 4
SAN GERMAN PR
00683
US

V. Phone/Fax

Practice location:
  • Phone: 787-309-4264
  • Fax:
Mailing address:
  • Phone: 787-309-4264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number21962
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: