Provider Demographics
NPI:1578572319
Name:MALDONADO RIVERA, MYRIAM (MD)
Entity Type:Individual
Prefix:
First Name:MYRIAM
Middle Name:
Last Name:MALDONADO 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:AQ35 AVE LAUREL
Mailing Address - Street 2:SANTA JUANITA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-4725
Mailing Address - Country:US
Mailing Address - Phone:787-995-0445
Mailing Address - Fax:787-995-0445
Practice Address - Street 1:AQ35 AVE LAUREL
Practice Address - Street 2:SANTA JUANITA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-4725
Practice Address - Country:US
Practice Address - Phone:787-995-0445
Practice Address - Fax:787-995-0445
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14247208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR21155MAOtherTRIPLE S HEALTH INSURANCE