=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548260276
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ARACELI RIVERA-SERRANO M.D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2005
-----------------------------------------------------
Last Update Date | 07/31/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 351 HOSTOS AVENUE SUITE 205
-----------------------------------------------------
City | MAYAGUEZ
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00680
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-834-6300
-----------------------------------------------------
Fax | 787-834-6203
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O BOX 6468
-----------------------------------------------------
City | MAYAGUEZ
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00681-6468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-834-6300
-----------------------------------------------------
Fax | 787-834-6203
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 170100000X
-----------------------------------------------------
Taxonomy Name | Ph.D. Medical Genetics
-----------------------------------------------------
License Number | 8227
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2471N0900X
-----------------------------------------------------
Taxonomy Name | Nuclear Medicine Technology Radiologic Technologist
-----------------------------------------------------
License Number | 056
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207U00000X
-----------------------------------------------------
Taxonomy Name | Nuclear Medicine Physician
-----------------------------------------------------
License Number | 8227
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------