Provider Demographics
NPI:1023259280
Name:VICENS-RIVERA, ARIANNE M (MD)
Entity type:Individual
Prefix:DR
First Name:ARIANNE
Middle Name:M
Last Name:VICENS-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 1:530 CAMINO LOS AQUINOS APT 171
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-7911
Mailing Address - Country:US
Mailing Address - Phone:787-586-3890
Mailing Address - Fax:
Practice Address - Street 1:UPR MEDICAL SCIENCES CAMPUS
Practice Address - Street 2:SUITE 209
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936
Practice Address - Country:US
Practice Address - Phone:787-777-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-18
Last Update Date:2021-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18194208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR038017900Medicaid