Healthcare Provider Details

I. General information

NPI: 1821926429
Provider Name (Legal Business Name): VITALIFERA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 AVENIDA EDUARDO RUBERTE OFICINA 101
PONCE PR
00728-1739
US

IV. Provider business mailing address

PO BOX 7757
PONCE PR
00732-7757
US

V. Phone/Fax

Practice location:
  • Phone: 787-259-5990
  • Fax:
Mailing address:
  • Phone: 787-600-1138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MIRIAM RIVERA MENDOZA
Title or Position: OWNER / MANAGING MEMBER
Credential: MD
Phone: 787-600-1138