Healthcare Provider Details

I. General information

NPI: 1316631997
Provider Name (Legal Business Name): STEPHANIE RIVERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UU22B IRIS STREET BORINQUEN GARDENS
SAN JUAN PR
00926
US

IV. Provider business mailing address

UU22A CALLE IRIS
SAN JUAN PR
00926-6425
US

V. Phone/Fax

Practice location:
  • Phone: 787-209-7884
  • Fax:
Mailing address:
  • Phone: 787-209-7884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number23411
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: