Healthcare Provider Details

I. General information

NPI: 1457371817
Provider Name (Legal Business Name): LOURDES RIVERA DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 09/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

B12 CALLE SANTA CRUZ URB. SANTA CRUZ
BAYAMON PR
00961-6902
US

IV. Provider business mailing address

PO BOX 3012
BAYAMON PR
00960-3012
US

V. Phone/Fax

Practice location:
  • Phone: 787-778-6676
  • Fax: 787-778-6676
Mailing address:
  • Phone: 787-778-6676
  • Fax: 787-778-6676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberDPM098
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: