Healthcare Provider Details

I. General information

NPI: 1003934589
Provider Name (Legal Business Name): ANA I RIVERA DE LA VEGA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PASEO SAN PABLO EDIF. DR. ARTURO CADILLA, SUITE 201
BAYAMON PR
00961-7019
US

IV. Provider business mailing address

100 GRAN BULEVAR PASEOS SUITE 112-272
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-778-8774
  • Fax: 787-269-6190
Mailing address:
  • Phone: 787-755-5321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number12244
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: