=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346380383
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANISSA VERONICA HERNANDEZ RIVERA M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2007
-----------------------------------------------------
Last Update Date | 05/02/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | C9 AVENIDA LUIS MUNOZ MARIN URB CAGUAX
-----------------------------------------------------
City | CAGUAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00725-9999
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-202-9387
-----------------------------------------------------
Fax | 939-204-9060
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 547
-----------------------------------------------------
City | GURABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00778-0547
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-656-3198
-----------------------------------------------------
Fax | 787-656-3199
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 14697
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------