Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 21954 | PR |
Y | 111NI0900X | Internist | 21954 | PR |
NPI | 1003131996 |
---|---|
Provider Name | Dr. Ileana Ivette Rivera-Burgos |
First Address | San Juan, PR 00936-8344 |
Second Address | San Juan, PR 00935 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2010 |
Last Update Date | 27/01/2022 |