MEDICARE: ITZEL S RIVERA MAFLA I

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	1041C0700X	Clinical Social Worker	24231	PR

General Provider Information

NPI Number	:	1982438446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ITZEL S RIVERA MAFLA I

Provider Business Mailing Address
First Line	:	PO BOX 1696
Second Line	:
City	:	TOA BAJA
State	:	PR
Zip	:	00951-1696
Country	:	US
Telephone Number	:	787-362-1203
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 2100
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00922-2100
Country	:	US
Telephone Number	:	787-766-4646
Fax Number	:

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

Provider Enumeration Date	:	08/28/2024
Last Update Date	:	08/28/2024

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Directions to “ ITZEL S RIVERA MAFLA I ” Practice Location

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