Provider Demographics
NPI:1538504071
Name:DR. ELIONEXSIS RIVERA RODRIGUEZ, CSP
Entity Type:Organization
Organization Name:DR. ELIONEXSIS RIVERA RODRIGUEZ, CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIONEXSIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-280-4889
Mailing Address - Street 1:C14 CALLE 4
Mailing Address - Street 2:URB. VENTURINI
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-2708
Mailing Address - Country:US
Mailing Address - Phone:787-280-4889
Mailing Address - Fax:787-280-4889
Practice Address - Street 1:AVE. EMERITO ESTRADA
Practice Address - Street 2:1001 ALTOS
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685
Practice Address - Country:US
Practice Address - Phone:787-280-4889
Practice Address - Fax:787-280-4889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10898208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1588638456OtherINDIVIDUAL NPI