Provider Demographics
NPI:1740379767
Name:RIVERA, EVELYN (MD)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
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 1:563 CALLE ARRIGOITIA
Mailing Address - Street 2:
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:787-756-8471
Practice Address - Street 1:CARR 172 KM3.3 AVE EL JIBARO
Practice Address - Street 2:CENTRO DE SALUD FAMILIAR MENONITA OFICINA 104
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR09202208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRHUMANAHEALTHPLANSPROther9180428
PRHUMANAINSURANCEPRINCOther9180428
PRLACRUZAZULDEPROther060695
PRMEDICALCARDSISTEMINCOther2-9202
PRASOCIACIONDEMAESTROOther3581-5
PRGLOBALHEALTHPLAN&INSOther129-9202PE
PRMENONITAOtherM00080
PRPREFERREDHEALTHOther203708
PRTRIPLE-SOther2-1761
PRAMERICANHEALTH,INC.Other1525