Provider Demographics
NPI:1689054975
Name:OFICINA PEDIATRICA DRA EVELYN RIVERA
Entity Type:Organization
Organization Name:OFICINA PEDIATRICA DRA EVELYN RIVERA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-714-0125
Mailing Address - Street 1:563 CALLE ARRIGOITIA
Mailing Address - Street 2:EXT. ROOSEVELT
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3726
Mailing Address - Country:US
Mailing Address - Phone:787-714-0125
Mailing Address - Fax:787-714-0125
Practice Address - Street 1:CARR 172 KM 3.3 OFIC. 104
Practice Address - Street 2:AVE. EL JIBARO
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:787-714-0125
Practice Address - Fax:787-714-0125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR09202261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty