Provider Demographics
NPI:1578864807
Name:MENDOZA-RIVERA, MARITZA I (RNBSN)
Entity Type:Individual
Prefix:MRS
First Name:MARITZA
Middle Name:I
Last Name:MENDOZA-RIVERA
Suffix:
Gender:F
Credentials:RNBSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:486 STREET KM1.4
Mailing Address - Street 2:HC-04 BOX 16317
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-7624
Mailing Address - Country:US
Mailing Address - Phone:787-448-4471
Mailing Address - Fax:
Practice Address - Street 1:129 STREET, SAN DANIEL
Practice Address - Street 2:COTTO STATION BOX 9550
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00613
Practice Address - Country:US
Practice Address - Phone:787-878-3552
Practice Address - Fax:787-879-8633
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16733163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice