Provider Demographics
NPI:1851594303
Name:RIVERA, BRENDALIZ (MD)
Entity Type:Individual
Prefix:
First Name:BRENDALIZ
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 1:57 REINA MORA
Mailing Address - Street 2:SABANERA DORADO
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-796-3038
Mailing Address - Fax:
Practice Address - Street 1:CARIBE MEDICAL PLAZA BLD
Practice Address - Street 2:SUITE 103
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-270-0520
Practice Address - Fax:787-270-0530
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR150812085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology