Provider Demographics
NPI:1780708875
Name:RIVERA, BASILISA (MD)
Entity type:Individual
Prefix:
First Name:BASILISA
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:NO. 37 ZORZAL ST.
Mailing Address - Street 2:CHALETS DE BAIROA
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-1246
Mailing Address - Country:US
Mailing Address - Phone:787-653-3434
Mailing Address - Fax:787-653-1753
Practice Address - Street 1:37 CALLE ZORZAL
Practice Address - Street 2:CHALETS DE BAIROA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-1246
Practice Address - Country:US
Practice Address - Phone:787-653-3434
Practice Address - Fax:787-653-1753
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11220282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren