Healthcare Provider Details

I. General information

NPI: 1144842931
Provider Name (Legal Business Name): NYDIA MARY CORREA RIVERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 111 KM 1.9 AVE. LOS PATRIOTAS
LARES PR
00669-0379
US

IV. Provider business mailing address

PO BOX 1772
LARES PR
00669
US

V. Phone/Fax

Practice location:
  • Phone: 787-897-2727
  • Fax: 787-897-2725
Mailing address:
  • Phone: 914-356-7759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number24327
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: