Provider Demographics
NPI:1528028222
Name:MANZANO-RIVERA, MARYLIA (MD)
Entity Type:Individual
Prefix:MRS
First Name:MARYLIA
Middle Name:
Last Name:MANZANO-RIVERA
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:URB. PALACIOS DEL RIO I.
Mailing Address - Street 2:CALLE GUANAJIBO 515
Mailing Address - City:TOA ALTU
Mailing Address - State:PR
Mailing Address - Zip Code:00953-5013
Mailing Address - Country:US
Mailing Address - Phone:787-797-0070
Mailing Address - Fax:787-730-2113
Practice Address - Street 1:PLAZA 829 CARR. 829 KM. 2.0
Practice Address - Street 2:LOCAL 2
Practice Address - City:TOA ALTU
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-797-0070
Practice Address - Fax:787-730-2113
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-25
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13116207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH55634Medicare UPIN
PR80292Medicare ID - Type Unspecified
H55634Medicare UPIN