Provider Demographics
NPI:1902209612
Name:RODRIGUEZ RIVERA, DIANA V
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:V
Last Name:RODRIGUEZ RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 AVE AMERICO MIRANDA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-2842
Mailing Address - Country:US
Mailing Address - Phone:787-765-7950
Mailing Address - Fax:
Practice Address - Street 1:1008 AVE AMERICO MIRANDA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-2842
Practice Address - Country:US
Practice Address - Phone:787-765-7950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-08
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR35152-R207N00000X
PAMT211301207R00000X
PAMD467320207R00000X
PR22207208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine