Provider Demographics
NPI:1497419022
Name:RIVERA SERRANO, LAURA CRISTINA (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:CRISTINA
Last Name:RIVERA SERRANO
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 1:1005 PASEO DEGETAU
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-2923
Mailing Address - Country:US
Mailing Address - Phone:787-375-4566
Mailing Address - Fax:
Practice Address - Street 1:1005 PASEO DEGETAU
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-2923
Practice Address - Country:US
Practice Address - Phone:787-375-4566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22573208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice