MEDICARE: DR. HILDA MARIA RIVERA MARIN PSYD.

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	103TC0700X	Clinical Psychologist	6274	PR

General Provider Information

NPI Number	:	1962969113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HILDA MARIA RIVERA MARIN PSYD.

Provider Business Mailing Address
First Line	:	URB GARDEN HILLS
Second Line	:	A8 ARTURO R MUJICA
City	:	GUAYNABO
State	:	PR
Zip	:	00966-2137
Country	:	US
Telephone Number	:	787-645-4549
Fax Number	:

Provider Business Practice Location Address
First Line	:	712 AVE PONCE DE LEON
Second Line	:
City	:	HATO REY
State	:	PR
Zip	:	00918-4512
Country	:	US
Telephone Number	:	787-507-7180
Fax Number	:

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

Provider Enumeration Date	:	02/25/2019
Last Update Date	:	10/18/2019

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