Provider Demographics
NPI:1568663391
Name:RIVERA, IRMA (MD)
Entity Type:Individual
Prefix:DR
First Name:IRMA
Middle Name:
Last Name: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:B5 CALLE 7
Mailing Address - Street 2:URB. ALTOS DE LA FUENTE
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-7321
Mailing Address - Country:US
Mailing Address - Phone:787-743-4752
Mailing Address - Fax:
Practice Address - Street 1:CALLE MAGA, ESQUINA CASIA
Practice Address - Street 2:URB. REPARTO METROPOLITANO
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00936
Practice Address - Country:US
Practice Address - Phone:787-765-0615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9055207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology