Healthcare Provider Details

I. General information

NPI: 1023271061
Provider Name (Legal Business Name): MARTA PILAR SUAREZ - RIVERA MD. MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 03/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE CONVENTO NUM. 252
SAN JUAN PR
00912
US

IV. Provider business mailing address

NEFROLOGIA PEDIATRICA PO BOX 29134
SAN JUAN PR
00929-0134
US

V. Phone/Fax

Practice location:
  • Phone: 787-726-1113
  • Fax:
Mailing address:
  • Phone: 787-726-1113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number17177
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: