Provider Demographics
NPI:1386707487
Name:RIVERA VIDAL, JAMINETT (MD)
Entity type:Individual
Prefix:DR
First Name:JAMINETT
Middle Name:
Last Name:RIVERA VIDAL
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:URB. VISTA POINT
Mailing Address - Street 2:3441 PASEO VERSATIL
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716
Mailing Address - Country:US
Mailing Address - Phone:787-842-1245
Mailing Address - Fax:
Practice Address - Street 1:URBANIZACION BELLA VISTA
Practice Address - Street 2:CALLE C #11
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:787-842-1245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15119208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics