Provider Demographics
NPI:1083249122
Name:MICOL HERNANDEZ RIVERA LLC
Entity Type:Organization
Organization Name:MICOL HERNANDEZ RIVERA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICOL
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-281-8106
Mailing Address - Street 1:1959 CALLE LOIZA STE 301
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00911-1873
Mailing Address - Country:US
Mailing Address - Phone:787-281-8106
Mailing Address - Fax:
Practice Address - Street 1:1959 CALLE LOIZA STE 301
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00911-1873
Practice Address - Country:US
Practice Address - Phone:787-281-8106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-09
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty