Provider Demographics
NPI:1598245995
Name:CLANCEY-RIVERA, MARIE GABRIELLE (MD STUDENT)
Entity Type:Individual
Prefix:MISS
First Name:MARIE
Middle Name:GABRIELLE
Last Name:CLANCEY-RIVERA
Suffix:
Gender:F
Credentials:MD STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 ZONA IND REPARADA 2
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-2347
Mailing Address - Country:US
Mailing Address - Phone:787-428-4220
Mailing Address - Fax:
Practice Address - Street 1:388 ZONA IND REPARADA 2
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-2347
Practice Address - Country:US
Practice Address - Phone:787-428-4220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program