Healthcare Provider Details

I. General information

NPI: 1952512907
Provider Name (Legal Business Name): SHEILA RIVERA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SC12 PLAZA 4 MANSIONSDELSUR
TOA BAJA PR
00949-4810
US

IV. Provider business mailing address

SC12 PLAZA 4 MANSIONESDELSUR
TOA BAJA PR
00949-4810
US

V. Phone/Fax

Practice location:
  • Phone: 787-784-5251
  • Fax: 787-782-0870
Mailing address:
  • Phone: 787-784-5251
  • Fax: 787-782-0870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number6807
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: