Provider Demographics
NPI:1942419841
Name:RIVERA, ADA IRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ADA
Middle Name:IRIS
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:RR 3 BOX 7289
Mailing Address - Street 2:LA PENINSULA
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-9346
Mailing Address - Country:US
Mailing Address - Phone:787-775-7927
Mailing Address - Fax:787-775-7994
Practice Address - Street 1:652 CARRETERA 28
Practice Address - Street 2:METROPOLITAN DETENTION CENTER
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00962-5700
Practice Address - Country:US
Practice Address - Phone:787-775-7927
Practice Address - Fax:787-775-7994
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR5888261QP2400X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine