Provider Demographics
NPI:1659359479
Name:RIVERA, LAURA (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
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:M15 CALLE PASCUA
Mailing Address - Street 2:URB. TERRAZAS DE GUAYNABO
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5419
Mailing Address - Country:US
Mailing Address - Phone:787-790-7442
Mailing Address - Fax:
Practice Address - Street 1:47 CALLE CARAZO
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5714
Practice Address - Country:US
Practice Address - Phone:787-731-7400
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7667174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR8388OtherIMC
PRPE-1684OtherPALIC
PR066888OtherCA
PR6570074OtherHUMANA
PR2-9498RIOtherTRIPLE-S