Provider Demographics
NPI:1124430467
Name:DRA VALENIE RIVERA ROIG PSC
Entity type:Organization
Organization Name:DRA VALENIE RIVERA ROIG PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VALENIE
Authorized Official - Middle Name:RIVERA
Authorized Official - Last Name:ROIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-648-8115
Mailing Address - Street 1:909 AVE TITO CASTRO STE 804
Mailing Address - Street 2:TORRE MEDICA SAN LUCAS
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-4725
Mailing Address - Country:US
Mailing Address - Phone:787-648-8115
Mailing Address - Fax:787-651-1498
Practice Address - Street 1:909 AVE TITO CASTRO STE 804
Practice Address - Street 2:TORRE MEDICA SAN LUCAS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4725
Practice Address - Country:US
Practice Address - Phone:787-648-8115
Practice Address - Fax:787-651-1498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14868207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR337401OtherCERTIFICADO DE REGISTRO DEPARTAMENTO DE ESTADO DE PUERTO RICO