Healthcare Provider Details

I. General information

NPI: 1275675175
Provider Name (Legal Business Name): ADA RODRIGUEZ RIVERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR #2 KM 8 5 BO JUAN SANCHEZ
BAYAMON PR
00960-0248
US

IV. Provider business mailing address

PO BOX 364944
SAN JUAN PR
00936-4944
US

V. Phone/Fax

Practice location:
  • Phone: 787-782-8250
  • Fax:
Mailing address:
  • Phone: 787-365-1891
  • Fax: 787-273-1848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number10419
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: