Provider Demographics
NPI:1043200710
Name:RIVERA LLAMAS, SANDRA I (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:I
Last Name:RIVERA LLAMAS
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:COND LA CORUNA 2023
Mailing Address - Street 2:APT 2301 CARR 177
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-460-6016
Mailing Address - Fax:787-268-3792
Practice Address - Street 1:AVE LOMAS VERDE 1790. BO MONACILLOS
Practice Address - Street 2:PLAZA OLMEDO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-752-6767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15244208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR102909Medicare UPIN
PRI-02909Medicare UPIN
PR22269Medicare ID - Type Unspecified
PR00-22269Medicare PIN