Provider Demographics
NPI:1265238265
Name:RIVERA FRATICELLY, MARIA I (MSM)
Entity type:Individual
Prefix:MISS
First Name:MARIA
Middle Name:
Last Name:RIVERA FRATICELLY
Suffix:I
Gender:
Credentials:MSM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 3 BOX 16111
Mailing Address - Street 2:
Mailing Address - City:AGUAS BUENAS
Mailing Address - State:PR
Mailing Address - Zip Code:00703-8379
Mailing Address - Country:US
Mailing Address - Phone:787-649-6041
Mailing Address - Fax:
Practice Address - Street 1:CALLE SAN RAFAEL A1 URBANIZACION PLA
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-0000
Practice Address - Country:US
Practice Address - Phone:787-503-5454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR003110163WS0121X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery