Provider Demographics
NPI:1356120265
Name:RIVERA RODRIGUEZ, WILMARIE
Entity type:Individual
Prefix:MRS
First Name:WILMARIE
Middle Name:
Last Name:RIVERA RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:WILMARIE
Other - Middle Name:
Other - Last Name:RIVERA RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, CCRN
Mailing Address - Street 1:500 CALLE MODESTA APT 1905
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-4410
Mailing Address - Country:US
Mailing Address - Phone:787-359-4347
Mailing Address - Fax:
Practice Address - Street 1:RECINTO DE CIENCIAS MEDICAS, ESCUELA DE ENFERMERIA
Practice Address - Street 2:PASEO DR. JOSE CELSO BARBOSA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-758-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9523895163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse