Healthcare Provider Details

I. General information

NPI: 1861181158
Provider Name (Legal Business Name): EVELYN RIVERA OCASIO MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CALLE FERROCARRIL STE 108
PONCE PR
00717-4105
US

IV. Provider business mailing address

450 CALLE FERROCARRIL STE 108
PONCE PR
00717-4105
US

V. Phone/Fax

Practice location:
  • Phone: 787-843-6282
  • Fax: 787-848-8401
Mailing address:
  • Phone: 787-843-6282
  • Fax: 787-848-8401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. BIFREDO J IRIZARRY
Title or Position: ADMINISTRATOR
Credential:
Phone: 787-475-2738