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General NPI Number Information
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NPI Number | 1639775349
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Entity Type | Individual
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Provider Name | LEANETTE MARIE GUZMAN RIVERA MD
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Gender | Female
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Dates
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Enumeration Date | 12/08/2020
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Last Update Date | 12/08/2020
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Provider Practice Location Address
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Address Line | URB. ESTANCIAS DEL MAYORAL CALLE LA CARRETA D-7
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City | VILLALBA
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State | PR
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Zip | 00766
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Country | US
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Telephone | 939-788-0288
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Fax |
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Provider Business Mailing Address
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Address Line | HC- 01 BOX 3133
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City | VILLALBA
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State | PR
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Zip | 00766-9701
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Country | US
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Telephone | 939-788-0288
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Fax |
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 22109
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License Number State | PR
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