Provider Demographics
NPI:1124749510
Name:RIVERA NIN, MAITESSU ADILEN (MD)
Entity type:Individual
Prefix:
First Name:MAITESSU
Middle Name:ADILEN
Last Name:RIVERA NIN
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 1:565 SECT PITILLO
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-7311
Mailing Address - Country:US
Mailing Address - Phone:939-285-4650
Mailing Address - Fax:
Practice Address - Street 1:565 SECT PITILLO
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-7311
Practice Address - Country:US
Practice Address - Phone:939-285-4650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22973208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice