Healthcare Provider Details

I. General information

NPI: 1962812115
Provider Name (Legal Business Name): MAYRA JIMENEZ RIVERA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2014
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CONSOLIDATED MALL, ANEXO B-5 202 AVENUE JOSE GAUTIER BENITEZ
CAGUAS PR
00725
US

IV. Provider business mailing address

CONSOLIDATED MALL, ANEXO B-5 202 AVENUE JOSE GAUTIER BENITEZ
CAGUAS PR
00725
US

V. Phone/Fax

Practice location:
  • Phone: 787-704-0705
  • Fax:
Mailing address:
  • Phone: 787-704-0705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number21594
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: