Provider Demographics
NPI:1003131996
Name:RIVERA-BURGOS, ILEANA IVETTE (MD)
Entity type:Individual
Prefix:DR
First Name:ILEANA
Middle Name:IVETTE
Last Name:RIVERA-BURGOS
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 1:1010 PASEO DEL VETERANO
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-2001
Mailing Address - Country:US
Mailing Address - Phone:787-492-0112
Mailing Address - Fax:
Practice Address - Street 1:1010 PASEO DEL VETERANO
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-2001
Practice Address - Country:US
Practice Address - Phone:787-492-0112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-02
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1565133N00000X
PR21954207R00000X, 207RR0500X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology