Healthcare Provider Details

I. General information

NPI: 1659050086
Provider Name (Legal Business Name): MYRNALI RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MYRNALI RIVERA

II. Dates (important events)

Enumeration Date: 07/13/2023
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 AVE PONCE DE LEON
GUAYNABO PR
00965-5602
US

IV. Provider business mailing address

247 CALLE ALMENDRO URB. GRAND PALM II
VEGA ALTA PR
00692
US

V. Phone/Fax

Practice location:
  • Phone: 939-777-0773
  • Fax:
Mailing address:
  • Phone: 939-777-0773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: