Healthcare Provider Details

I. General information

NPI: 1629591276
Provider Name (Legal Business Name): ELAINE ILEANA RIVERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 AVE ASHFORD LBBY AREA
SAN JUAN PR
00907-1511
US

IV. Provider business mailing address

12 AVE ALBOLOTE APT 88
GUAYNABO PR
00969-5505
US

V. Phone/Fax

Practice location:
  • Phone: 787-721-2160
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number24324
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: