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General NPI Number Information
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NPI Number | 1063409696
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Entity Type | Individual
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Provider Name | MAYRA RIVERA MD
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Gender | Female
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Dates
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Enumeration Date | 09/29/2005
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Last Update Date | 05/30/2008
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Provider Practice Location Address
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Address Line | SAN JUAN CITY HOSPITAL MEDICAL CENTER
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City | SAN JUAN
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State | PR
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Zip | 00936
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Country | US
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Telephone | 787-766-2223
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Fax |
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Provider Business Mailing Address
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Address Line | PLAZA 4 SC-12 MANSION DEL SUR
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City | TOA BAJA
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State | PR
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Zip | 00949
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Country | US
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Telephone | 787-784-5251
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 16091
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License Number State | PR
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