Provider Demographics
NPI:1659370872
Name:RIVERA, JANIVETTE (MD)
Entity Type:Individual
Prefix:
First Name:JANIVETTE
Middle Name:
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:PO BOX 2329
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-4329
Mailing Address - Country:US
Mailing Address - Phone:787-385-7019
Mailing Address - Fax:787-845-4044
Practice Address - Street 1:809 CARR 153 STE 13
Practice Address - Street 2:PLAZA SANTA ISABEL
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757-4009
Practice Address - Country:US
Practice Address - Phone:787-845-4044
Practice Address - Fax:787-845-4044
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13859174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR21476OtherMEDICARE
PRH83460Medicare UPIN