Provider Demographics
NPI:1417002718
Name:RIVERA, AITZA MARIA
Entity Type:Individual
Prefix:DR
First Name:AITZA
Middle Name:MARIA
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. SANTA JUANITA, CALLE 41
Mailing Address - Street 2:AP 13
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-637-7413
Mailing Address - Fax:
Practice Address - Street 1:40 CALLE BETANCES
Practice Address - Street 2:LOCAL FA 10, CANTON MALL
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6200
Practice Address - Country:US
Practice Address - Phone:787-785-3170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR26641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice