Provider Demographics
NPI:1396499265
Name:ALICEA RIVERA, MARANGELIE (MD)
Entity type:Individual
Prefix:DR
First Name:MARANGELIE
Middle Name:
Last Name:ALICEA 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:POLARIS FQ19 IRLANDA HEIGHTS
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956
Mailing Address - Country:US
Mailing Address - Phone:787-383-6626
Mailing Address - Fax:
Practice Address - Street 1:URB SAN ALFONSO, DEGETAU A17
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-743-5353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23517208D00000X
PR1387PA363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice