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General NPI Number Information
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NPI Number | 1588638456
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Entity Type | Individual
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Provider Name | ELIONEXSIS RIVERA M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/15/2006
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Last Update Date | 10/15/2012
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Provider Practice Location Address
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Address Line | AVE EMERITO ESTRADA 1001 ALTOS
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City | SAN SEBASTIAN
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State | PR
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Zip | 00685-3113
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Country | US
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Telephone | 787-280-4889
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Fax | 787-280-4889
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Provider Business Mailing Address
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Address Line | C14 CALLE 4 VENTURINI
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City | SAN SEBASTIAN
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State | PR
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Zip | 00685-2708
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Country | US
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Telephone | 787-280-2924
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Fax | 787-280-2924
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 10898
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License Number State | PR
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