Provider Demographics
NPI:1457486946
Name:ANDINO-RIVAS, ADA IVETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:ADA
Middle Name:IVETTE
Last Name:ANDINO-RIVAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 191696
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-1696
Mailing Address - Country:US
Mailing Address - Phone:787-283-6978
Mailing Address - Fax:
Practice Address - Street 1:AVE. CASA LINDA #1 CARR. 177 LOS FILTROS
Practice Address - Street 2:SUITE 101
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-789-1919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11,6662084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG41670Medicare UPIN