Provider Demographics
NPI:1699115493
Name:BURGOS RIOS, MARICARMEN
Entity type:Individual
Prefix:
First Name:MARICARMEN
Middle Name:
Last Name:BURGOS RIOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARI
Other - Middle Name:CARMEN
Other - Last Name:BURGOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:BH17 PLAZA 17
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-6056
Mailing Address - Country:US
Mailing Address - Phone:787-748-2665
Mailing Address - Fax:
Practice Address - Street 1:BH17 PLAZA 17
Practice Address - Street 2:
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-6056
Practice Address - Country:US
Practice Address - Phone:787-748-2665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR29321-R208000000X
PR193212080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics