Provider Demographics
NPI:1093781692
Name:RODRIGUEZ-RIVERA, OLGA L (MD)
Entity Type:Individual
Prefix:DR
First Name:OLGA
Middle Name:L
Last Name:RODRIGUEZ-RIVERA
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:BAYAMON MEDICAL PLZ
Mailing Address - Street 2:SUITE 607
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-7200
Mailing Address - Country:US
Mailing Address - Phone:787-780-0300
Mailing Address - Fax:787-269-5060
Practice Address - Street 1:BAYAMON MEDICAL PLZ
Practice Address - Street 2:SUITE 607
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-7200
Practice Address - Country:US
Practice Address - Phone:787-780-0300
Practice Address - Fax:787-269-5060
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3310174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0333310OtherUIA
PR6362OtherIMC
PR74529OtherATLA
PR204015Other204015
PR990557OtherMEDICARE MUCHO MAS
PR3853486OtherCIGNA
PR7975OtherAMPR
PR064383OtherLA CRUZ AZUL PUERTO RICO
PR6190065OtherHUMANA INSURANCE
PRPE0118OtherPALI
PRE31123Medicare UPIN
PR0026053Medicare ID - Type UnspecifiedMEDICARE