=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851604300
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILMARIE RIVERA MORALES M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2010
-----------------------------------------------------
Last Update Date | 03/15/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | AVENIDA ANTONIO R.BARCELO #14 KM 72.3
-----------------------------------------------------
City | CAYEY
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 939-283-9296
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1138
-----------------------------------------------------
City | COMERIO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00782-1138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number | 12564-I
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 19701
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------