Healthcare Provider Details

I. General information

NPI: 1639775349
Provider Name (Legal Business Name): LEANETTE MARIE GUZMAN RIVERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. ESTANCIAS DEL MAYORAL CALLE LA CARRETA D-7
VILLALBA PR
00766
US

IV. Provider business mailing address

HC- 01 BOX 3133
VILLALBA PR
00766-9701
US

V. Phone/Fax

Practice location:
  • Phone: 939-788-0288
  • Fax:
Mailing address:
  • Phone: 939-788-0288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number22109
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: