Provider Demographics
NPI:1902209612
Name:RODRIGUEZ RIVERA, DIANA V
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:V
Last Name:RODRIGUEZ RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 371867
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737-1867
Mailing Address - Country:US
Mailing Address - Phone:939-336-9019
Mailing Address - Fax:
Practice Address - Street 1:174 CALLE LUIS BARRERAS S
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-4615
Practice Address - Country:US
Practice Address - Phone:939-336-9019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-08
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22207207N00000X, 208D00000X
PAMT211301207R00000X
PAMD467320207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine