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General NPI Number Information
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NPI Number | 1073620688
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Entity Type | Organization
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Legal Business Name | MARISOL RIVERA MISLA
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 165-E CALLE MENDEZ VIGO
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City | MAYAGUEZ
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State | PR
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Zip | 00680
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Country | US
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Telephone | 787-832-7246
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Fax | 787-831-7246
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Provider Business Mailing Address
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Address Line | PO BOX 6666
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City | MAYAGUEZ
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State | PR
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Zip | 00681-6666
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Country | US
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Telephone | 787-832-7246
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Fax | 787-831-7246
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARISOL RIVERA
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Credential | M.D.
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Telephone | 787-832-7246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 9895
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License Number State | PR
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