Provider Demographics
NPI:1972568160
Name:RIVERA-SANTIAGO, HILDA M (MD)
Entity Type:Individual
Prefix:DR
First Name:HILDA
Middle Name:M
Last Name:RIVERA-SANTIAGO
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 1:3750 COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-3117
Mailing Address - Country:US
Mailing Address - Phone:210-922-7000
Mailing Address - Fax:210-924-4107
Practice Address - Street 1:6315 S ZARZAMORA ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78211-3218
Practice Address - Country:US
Practice Address - Phone:210-922-7000
Practice Address - Fax:210-924-4107
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7642208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120573405OtherTEXAS PROVIDER IDENTIFICATION MEDICAID