Provider Demographics
NPI:1598843534
Name:RIVERA ORELLANO, OLGA D
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:D
Last Name:RIVERA ORELLANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STREET 12 L-4 SANTA JUANA II
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2020 AVE BORINQUEN
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00915-3822
Practice Address - Country:US
Practice Address - Phone:787-268-4171
Practice Address - Fax:787-727-3695
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16551208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice