Provider Demographics
NPI:1538267737
Name:RIVERA, AIXA TORRES (DO)
Entity type:Individual
Prefix:DR
First Name:AIXA
Middle Name:TORRES
Last Name:RIVERA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 CALLE RAFAEL LASA
Mailing Address - Street 2:
Mailing Address - City:AGUAS BUENAS
Mailing Address - State:PR
Mailing Address - Zip Code:00703-3343
Mailing Address - Country:US
Mailing Address - Phone:787-732-8514
Mailing Address - Fax:
Practice Address - Street 1:45 CALLE RAFAEL LASA
Practice Address - Street 2:
Practice Address - City:AGUAS BUENAS
Practice Address - State:PR
Practice Address - Zip Code:00703-3343
Practice Address - Country:US
Practice Address - Phone:787-732-8514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1576122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist