Provider Demographics
NPI:1255515193
Name:RIVERA - ROMAN, KEILA LIZ (MD)
Entity type:Individual
Prefix:DR
First Name:KEILA
Middle Name:LIZ
Last Name:RIVERA - ROMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KEILA
Other - Middle Name:LIZ
Other - Last Name:RIVERA ROMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 366527
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-6527
Mailing Address - Country:US
Mailing Address - Phone:787-765-7320
Mailing Address - Fax:787-765-3230
Practice Address - Street 1:300 AVE DOMENECH
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3509
Practice Address - Country:US
Practice Address - Phone:787-765-7320
Practice Address - Fax:787-765-3230
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17545207ZP0007X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic Pathology