Provider Demographics
NPI:1023187846
Name:RIVERA, AIXA (OD)
Entity Type:Individual
Prefix:DR
First Name:AIXA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 AVE ROOSEVELT
Mailing Address - Street 2:PLAZA LAS AMERICAS SUITE 173
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-777-0990
Mailing Address - Fax:
Practice Address - Street 1:525 AVE ROOSEVELT
Practice Address - Street 2:PLAZA LAS AMERICAS SUITE 173
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-777-0990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR282152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist