Healthcare Provider Details

I. General information

NPI: 1215036520
Provider Name (Legal Business Name): MARILUZ RIVERA-HERNANDEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CASIA STREET VA CARIBBEAN HEALTH CARE SYSTEM
SAN JUAN PR
00921
US

IV. Provider business mailing address

7 RIVERSIDE BLVD CARMEN HILLS
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-7582
  • Fax:
Mailing address:
  • Phone: 787-599-7145
  • Fax: 787-641-4380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number225132
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number13511
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: