Healthcare Provider Details

I. General information

NPI: 1124312657
Provider Name (Legal Business Name): SULEYKA MILAGROS OLIVERO-RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSPITAL SAN LUCAS
PONCE PR
00716
US

IV. Provider business mailing address

PO BOX 800068
PONCE PR
00780-0068
US

V. Phone/Fax

Practice location:
  • Phone: 787-844-2078
  • Fax: 787-844-2545
Mailing address:
  • Phone: 787-844-2078
  • Fax: 787-844-2545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number18,668
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number18668
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: