Provider Demographics
NPI:1588930606
Name:DRA LILIA RIVERA PSC
Entity type:Organization
Organization Name:DRA LILIA RIVERA PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-250-1746
Mailing Address - Street 1:239 AVE ARTERIAL HOSTOS
Mailing Address - Street 2:CAPITAL CENTER 306
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-1474
Mailing Address - Country:US
Mailing Address - Phone:787-250-7746
Mailing Address - Fax:787-250-1746
Practice Address - Street 1:239 AVE ARTERIAL HOSTOS
Practice Address - Street 2:CAPITAL CENTER 306
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-1474
Practice Address - Country:US
Practice Address - Phone:787-250-7746
Practice Address - Fax:787-250-1746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8335207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0080378OtherINDIVIDUAL NUMBER
PR0080378Medicare UPIN
PR80378Medicare UPIN
PRB63429Medicare UPIN
83501BMedicare UPIN
PR0080378OtherINDIVIDUAL NUMBER