Provider Demographics
NPI:1881825362
Name:HIDALGO - RIVERA, MARIE BERNADINE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:BERNADINE
Last Name:HIDALGO - 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 1:106 CALLE DR GONZALEZ
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-2909
Mailing Address - Country:US
Mailing Address - Phone:787-589-7272
Mailing Address - Fax:
Practice Address - Street 1:EDIFICIO CENTERPLEX SUITE 309
Practice Address - Street 2:CARR 2 KM 133.5 BO GUANABANO
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-589-7272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR182522084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology