Healthcare Provider Details

I. General information

NPI: 1710534797
Provider Name (Legal Business Name): NICOLE RIVERA BOBE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2019
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 AVE AMERICO MIRANDA
SAN JUAN PR
00921-2842
US

IV. Provider business mailing address

29 CALLE WASHINGTON
SAN JUAN PR
00907-1510
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-7908
  • Fax:
Mailing address:
  • Phone: 939-399-0422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number23144
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number23144
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number23144
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: