Provider Demographics
NPI:1659398949
Name:FONSECA RIVERA, EVELYN M (MD)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:M
Last Name:FONSECA RIVERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PMB 331 S-1
Mailing Address - Street 2:P O BOX 4961
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL HIMA CAGUAS PISO G AVENIDA LUIS MUNOZ MARIN
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-744-8686
Practice Address - Fax:787-258-1125
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2018-06-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR9601207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2905OtherAMERICAN HEALTH
PR67892OtherCRUZ AZUL
PR821378OtherMEDICARE Y MUCHO MAS
PR82480OtherPALI
PR9601OtherTRIPLE S
PR1859OtherPREFFERRED MEDICAL CHOICE
PR8000210OtherHUMANA GOLD PLUS
PR8000210OtherHUMANA
PR9601OtherCOSVI
PRE-91208Medicare UPIN