Provider Demographics
NPI:1629186200
Name:RIVERA, MAGALI S (MD)
Entity Type:Individual
Prefix:MRS
First Name:MAGALI
Middle Name:S
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:URB DORADO DEL MAR P-16
Mailing Address - Street 2:SIRENA ST
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7 CALLE ANTONIO ALCAZAR
Practice Address - Street 2:FLORIDA
Practice Address - City:FLORIDA
Practice Address - State:PR
Practice Address - Zip Code:00650-1912
Practice Address - Country:US
Practice Address - Phone:787-822-2170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7593208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF30150Medicare UPIN
PR80878Medicare ID - Type UnspecifiedMEDICARE