Provider Demographics
NPI:1154415339
Name:RIVERA, IVELIZA RIVERA (MD)
Entity type:Individual
Prefix:
First Name:IVELIZA
Middle Name:RIVERA
Last Name: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:CALLE MCKINLEY 151E OFIC 3
Mailing Address - Street 2:
Mailing Address - City:MAYAQUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-831-6199
Mailing Address - Fax:787-831-6199
Practice Address - Street 1:CALLE MCKINLEY 151E OFIC 3
Practice Address - Street 2:
Practice Address - City:MAYAQUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-831-6199
Practice Address - Fax:787-831-6199
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6858208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR79567Medicare UPIN