Healthcare Provider Details

I. General information

NPI: 1861305922
Provider Name (Legal Business Name): MD360 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 PONCE BYP
PONCE PR
00717-1321
US

IV. Provider business mailing address

2919 CALLE GUILARTE
PONCE PR
00716-4805
US

V. Phone/Fax

Practice location:
  • Phone: 787-849-0956
  • Fax: 787-812-0910
Mailing address:
  • Phone: 787-717-2925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. LILLIAN VICTORIA RIVERA
Title or Position: OWNER
Credential: MD
Phone: 787-717-2925