Provider Demographics
NPI:1043495617
Name:RIVERA-VARGAS, DALILA
Entity Type:Individual
Prefix:MRS
First Name:DALILA
Middle Name:
Last Name:RIVERA-VARGAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 9866
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-9751
Mailing Address - Country:US
Mailing Address - Phone:787-242-7517
Mailing Address - Fax:
Practice Address - Street 1:43 CALLE DR VEVE
Practice Address - Street 2:EDIFICIO GROVAS RODRIGUEZ
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-4100
Practice Address - Country:US
Practice Address - Phone:787-892-5030
Practice Address - Fax:787-264-7279
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR002979247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist