Healthcare Provider Details

I. General information

NPI: 1316159007
Provider Name (Legal Business Name): CAMILLE RIVERA CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR.173 RAMAL 792 BO. JAGUEYES
AGUAS BUENAS PR
00703
US

IV. Provider business mailing address

HC -01 BOX 25795
CAGUAS PR
00725
US

V. Phone/Fax

Practice location:
  • Phone: 787-226-5840
  • Fax: 787-281-7355
Mailing address:
  • Phone: 787-226-5840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1199
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: