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General NPI Number Information
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NPI Number | 1437104957
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Entity Type | Individual
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Provider Name | VIVIAN T. RIVERA MD
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Gender | Female
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 09/06/2012
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Provider Practice Location Address
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Address Line | 280 AVE MARGINAL KENNEDY
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City | GUAYNABO
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State | PR
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Zip | 00968-1746
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Country | US
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Telephone | 973-202-0198
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Fax | 787-620-5761
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Provider Business Mailing Address
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Address Line | 280 AVE MARGINAL KENNEDY
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City | GUAYNABO
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State | PR
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Zip | 00968-1746
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Country | US
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Telephone | 973-202-0198
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Fax | 787-620-5761
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 25MA07365200
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License Number State | NJ
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