Provider Demographics
NPI:1306043765
Name:RIVERA, IRIS MIGDALIA (RN BSN)
Entity Type:Individual
Prefix:MS
First Name:IRIS
Middle Name:MIGDALIA
Last Name:RIVERA
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:REPARTO ANAMAR
Mailing Address - Street 2:BAMBU STREET #36
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-785-5824
Mailing Address - Fax:
Practice Address - Street 1:RR 11 BOX 3836
Practice Address - Street 2:BO. ALDEA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-9306
Practice Address - Country:US
Practice Address - Phone:787-785-5824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR25006163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse