Provider Demographics
NPI:1689894974
Name:RIVERA-MISLA, MARISOL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARISOL
Middle Name:
Last Name:RIVERA-MISLA
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 1:165 CALLE MENDEZ VIGO E
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-5049
Mailing Address - Country:US
Mailing Address - Phone:787-832-7246
Mailing Address - Fax:787-831-7246
Practice Address - Street 1:CALLE MENDEZ VIGO 165-E
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-832-7246
Practice Address - Fax:787-831-7246
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9895207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG00370Medicare UPIN
PR84617Medicare ID - Type Unspecified