Provider Demographics
NPI:1003131996
Name:RIVERA-BURGOS, ILEANA IVETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:ILEANA
Middle Name:IVETTE
Last Name:RIVERA-BURGOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70344
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8344
Mailing Address - Country:US
Mailing Address - Phone:787-480-2700
Mailing Address - Fax:
Practice Address - Street 1:150 AVE AMERICO MIRANDA
Practice Address - Street 2:AREA DE CENTRO MEDICO METROPOLITANO BO MONACILLOS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00935
Practice Address - Country:US
Practice Address - Phone:787-763-4149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-02
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR33578R390200000X
PR1565133N00000X
21954390200000X
PR21954207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No133N00000XDietary & Nutritional Service ProvidersNutritionist