Provider Demographics
NPI:1326025180
Name:RIVERA GUASP, AIXA (MD)
Entity Type:Individual
Prefix:MRS
First Name:AIXA
Middle Name:
Last Name:RIVERA GUASP
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:PMB 176 1353 RD 19
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-2700
Mailing Address - Country:US
Mailing Address - Phone:787-726-3611
Mailing Address - Fax:
Practice Address - Street 1:650 LLOVERAS
Practice Address - Street 2:EDIFICIO CENTRO PLAZA SUITE 201
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00909
Practice Address - Country:US
Practice Address - Phone:787-726-3611
Practice Address - Fax:787-726-3611
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10277174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR10277OtherMEDICAL LICENSE
PR10277OtherMEDICAL LICENSE
PRF86899Medicare UPIN