Healthcare Provider Details

I. General information

NPI: 1972936300
Provider Name (Legal Business Name): ZURISADAI RIVERA ACOSTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2013
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 AVE PONCE DE LEON
SAN JUAN PR
00917-5022
US

IV. Provider business mailing address

782 CALLE TEODORO AGUILAR
SAN JUAN PR
00923-2436
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2000
  • Fax:
Mailing address:
  • Phone: 787-210-9252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number19272
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: