Healthcare Provider Details

I. General information

NPI: 1114553724
Provider Name (Legal Business Name): SARAH RIVERA DE PENA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2020
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 F.D. ROOSEVELT AVENUE LA TORRE DE PLAZA, SUITE 409
SAN JUAN PR
00918
US

IV. Provider business mailing address

PO BOX 1300
GUAYAMA PR
00785-1300
US

V. Phone/Fax

Practice location:
  • Phone: 409-747-3376
  • Fax: 409-772-4456
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number24527
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: