Provider Demographics
NPI:1073620688
Name:MARISOL RIVERA MISLA
Entity Type:Organization
Organization Name:MARISOL RIVERA MISLA
Other - Org Name:CARIBBEAN PAIN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARISOL
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-832-7246
Mailing Address - Street 1:PO BOX 6666
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-6666
Mailing Address - Country:US
Mailing Address - Phone:787-832-7246
Mailing Address - Fax:787-831-7246
Practice Address - Street 1:165-E CALLE MENDEZ VIGO
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-832-7246
Practice Address - Fax:787-831-7246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9895207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR87618OtherTRIPLE SSS
PR9485OtherFIRST MEDICAL
PR87618OtherTRIPLE SSS
PR84617Medicare ID - Type Unspecified
PR9485OtherFIRST MEDICAL