Healthcare Provider Details

I. General information

NPI: 1053381988
Provider Name (Legal Business Name): LIZZA IVETTE RIVERA D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 ZONA IND REPARADA 2
PONCE PR
00716-2347
US

IV. Provider business mailing address

4410 W 16TH AVE SUITE 52
HIALEAH FL
33012-7100
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-2575
  • Fax:
Mailing address:
  • Phone: 305-825-9899
  • Fax: 305-825-9858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number1991
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN21702
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: