Provider Demographics
NPI:1508872227
Name:RIVERA BORGES, IVELISSE (MD)
Entity Type:Individual
Prefix:MRS
First Name:IVELISSE
Middle Name:
Last Name:RIVERA BORGES
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:PO BOX 195612
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-5612
Mailing Address - Country:US
Mailing Address - Phone:787-562-3334
Mailing Address - Fax:787-773-8040
Practice Address - Street 1:735 PONCE DE LEON AVENUE
Practice Address - Street 2:HOSP AUXILIO MUTUO EDIFICIO SAN VICENTE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5022
Practice Address - Country:US
Practice Address - Phone:787-568-5486
Practice Address - Fax:787-773-8041
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12948207RN0300X, 246ZN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZN0300XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherNephrology
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR90266RJOtherSSS
90266RSOtherSSS INSURANCE
PR90266RJOtherSSS
PRH03053Medicare UPIN