Healthcare Provider Details

I. General information

NPI: 1124368139
Provider Name (Legal Business Name): XIOMARA YOLANDA RIVERA HENRANDEZ D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2013
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 WILSON BLVD STE 960
ARLINGTON VA
22209-2509
US

IV. Provider business mailing address

PASEOS LOS CORALES I #593 ST. MAR INDICO
DORADO PR
00646-4514
US

V. Phone/Fax

Practice location:
  • Phone: 703-465-5080
  • Fax:
Mailing address:
  • Phone: 787-414-6354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number0401415817
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: