MEDICARE: MRS. MARICARMEN RIVERA-IGUINA BSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	3799	PR

General Provider Information

NPI Number	:	1104032812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARICARMEN RIVERA-IGUINA BSW

Provider Business Mailing Address
First Line	:	PO BOX 1271
Second Line	:	BARRIO NAVARRO
City	:	GURABO
State	:	PR
Zip	:	00778-1271
Country	:	US
Telephone Number	:	787-747-2363
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 CALLE CERRA
Second Line	:	PDA 15 CDT GUALBERTO RABELL
City	:	SAN JUAN
State	:	PR
Zip	:	00907-5104
Country	:	US
Telephone Number	:	787-747-2363
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	07/08/2007

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