Healthcare Provider Details

I. General information

NPI: 1740379767
Provider Name (Legal Business Name): EVELYN RIVERA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 172 KM3.3 AVE EL JIBARO CENTRO DE SALUD FAMILIAR MENONITA OFICINA 104
CIDRA PR
00739
US

IV. Provider business mailing address

563 CALLE ARRIGOITIA
SAN JUAN PR
00918-3726
US

V. Phone/Fax

Practice location:
  • Phone: 787-714-0125
  • Fax: 787-714-0125
Mailing address:
  • Phone: 787-714-0125
  • Fax: 787-756-8471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number09202
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierHUMANAHEALTHPLANSPR
Identifier TypeOTHER
Identifier StatePR
Identifier Issuer9180428
# 2
IdentifierHUMANAINSURANCEPRINC
Identifier TypeOTHER
Identifier StatePR
Identifier Issuer9180428
# 3
IdentifierLACRUZAZULDEPR
Identifier TypeOTHER
Identifier StatePR
Identifier Issuer060695
# 4
IdentifierMEDICALCARDSISTEMINC
Identifier TypeOTHER
Identifier StatePR
Identifier Issuer2-9202
# 5
IdentifierASOCIACIONDEMAESTRO
Identifier TypeOTHER
Identifier StatePR
Identifier Issuer3581-5
# 6
IdentifierGLOBALHEALTHPLAN&INS
Identifier TypeOTHER
Identifier StatePR
Identifier Issuer129-9202PE
# 7
IdentifierMENONITA
Identifier TypeOTHER
Identifier StatePR
Identifier IssuerM00080
# 8
IdentifierPREFERREDHEALTH
Identifier TypeOTHER
Identifier StatePR
Identifier Issuer203708
# 9
IdentifierTRIPLE-S
Identifier TypeOTHER
Identifier StatePR
Identifier Issuer2-1761
# 10
IdentifierAMERICANHEALTH,INC.
Identifier TypeOTHER
Identifier StatePR
Identifier Issuer1525

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: