Provider Demographics
NPI:1659436756
Name:RIVERA BILBRAUT, MARISOL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARISOL
Middle Name:
Last Name:RIVERA BILBRAUT
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:CHIPRE ST. PUERTO NUEVO
Mailing Address - Street 2:710
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920
Mailing Address - Country:US
Mailing Address - Phone:939-383-6771
Mailing Address - Fax:
Practice Address - Street 1:710 CALLE CHIPRE
Practice Address - Street 2:PUERTO NUEVO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-5120
Practice Address - Country:US
Practice Address - Phone:787-688-1397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13522207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0000000OtherNONE