Healthcare Provider Details

I. General information

NPI: 1003370685
Provider Name (Legal Business Name): TANIA MARIE AGUILA RIVERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 AVE LUIS MUNOZ RIVERA
SAN JUAN PR
00918-3112
US

IV. Provider business mailing address

PO BOX 779
GARROCHALES PR
00652-0779
US

V. Phone/Fax

Practice location:
  • Phone: 787-522-2482
  • Fax:
Mailing address:
  • Phone: 787-452-9199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number24865
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: