Healthcare Provider Details

I. General information

NPI: 1669496873
Provider Name (Legal Business Name): MARIBEL CAMPOS RIVERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 ROAD 21 KM 0.8 MONACILLO WARD FIRST FLOOR FORWARD CENTER
SAN JUAN PR
00927
US

IV. Provider business mailing address

PO BOX 70344 PMB #65
SAN JUAN PR
00936-8344
US

V. Phone/Fax

Practice location:
  • Phone: 939-237-4793
  • Fax: 866-379-9205
Mailing address:
  • Phone: 787-436-8857
  • Fax: 866-379-9205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number13254-829
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number13254
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13254
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number13254
License Number StatePR
# 5
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number13254
License Number StatePR
# 6
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number13254
License Number StatePR
# 7
Primary TaxonomyN
Taxonomy Code2080B0002X
TaxonomyPediatric Obesity Medicine Physician
License Number13254
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: