Healthcare Provider Details

I. General information

NPI: 1669556395
Provider Name (Legal Business Name): NATIVIDAD RODRIGUEZ RIVERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LODI STREET A2 VILLA LUARCA
SAN JUAN PR
00924-0000
US

IV. Provider business mailing address

PO BOX 366294
SAN JUAN PR
00936-6294
US

V. Phone/Fax

Practice location:
  • Phone: 787-751-5955
  • Fax: 787-767-0516
Mailing address:
  • Phone: 787-751-5955
  • Fax: 787-767-0516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4893
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: