Provider Demographics
NPI:1659050086
Name:RIVERA, MYRNALI
Entity Type:Individual
Prefix:
First Name:MYRNALI
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MYRNALI
Other - Middle Name:
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:247 CALLE ALMENDRO
Mailing Address - Street 2:URB. GRAND PALM II
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692
Mailing Address - Country:US
Mailing Address - Phone:939-777-0773
Mailing Address - Fax:
Practice Address - Street 1:125 AVE PONCE DE LEON
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00965-5602
Practice Address - Country:US
Practice Address - Phone:939-777-0773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine