Healthcare Provider Details

I. General information

NPI: 1699736819
Provider Name (Legal Business Name): RUTH RIVERA-MALAVE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

B36 CALLE MARGINAL VELEZ
MANATI PR
00674-5435
US

IV. Provider business mailing address

PO BOX 13958
SAN JUAN PR
00908-3958
US

V. Phone/Fax

Practice location:
  • Phone: 787-854-5266
  • Fax: 787-884-0663
Mailing address:
  • Phone: 787-854-5266
  • Fax: 787-884-0663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number8140
License Number StatePR

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: