Healthcare Provider Details

I. General information

NPI: 1265159131
Provider Name (Legal Business Name): TIVA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2022
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 AVE ESCORIAL URB CAPARRA HEIGHTS
SAN JUAN PR
00920-3508
US

IV. Provider business mailing address

PO BOX 367284
SAN JUAN PR
00936-7284
US

V. Phone/Fax

Practice location:
  • Phone: 787-781-7478
  • Fax:
Mailing address:
  • Phone: 787-608-7368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: EDUARDO IRIZARRY NIEVES
Title or Position: PRESIDENT
Credential: MD
Phone: 787-608-7368