Provider Demographics
NPI:1801943097
Name:RIVERA, AIDA I (DMD)
Entity type:Individual
Prefix:
First Name:AIDA
Middle Name:I
Last Name:RIVERA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1212
Mailing Address - Street 2:
Mailing Address - City:AGUAS BUENAS
Mailing Address - State:PR
Mailing Address - Zip Code:00703-1212
Mailing Address - Country:US
Mailing Address - Phone:787-732-3577
Mailing Address - Fax:787-732-3577
Practice Address - Street 1:48 CALLE RAFAEL LASA
Practice Address - Street 2:
Practice Address - City:AGUAS BUENAS
Practice Address - State:PR
Practice Address - Zip Code:00703-3321
Practice Address - Country:US
Practice Address - Phone:787-732-3577
Practice Address - Fax:787-732-3577
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR400136OtherHUMANA
PR41912RIOtherTRIPLE S
PR7048OtherFIRST MEDICAL CARD SYSTEM
PR206282OtherPREFFERED HEALTH
PR041665OtherCRUZ AZUL