Healthcare Provider Details

I. General information

NPI: 1851594303
Provider Name (Legal Business Name): BRENDALIZ RIVERA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARIBE MEDICAL PLAZA BLD SUITE 103
VEGA ALTA PR
00692
US

IV. Provider business mailing address

57 REINA MORA SABANERA DORADO
DORADO PR
00646
US

V. Phone/Fax

Practice location:
  • Phone: 787-270-0520
  • Fax: 787-270-0530
Mailing address:
  • Phone: 787-796-3038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number15081
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: