=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023259280
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ARIANNE M VICENS-RIVERA M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2009
-----------------------------------------------------
Last Update Date | 03/14/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | UPR MEDICAL SCIENCES CAMPUS SUITE 209
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-777-3535
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 530 CAMINO LOS AQUINOS APT 171
-----------------------------------------------------
City | TRUJILLO ALTO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00976-7911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-586-3890
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 18194
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------