Provider Demographics
NPI:1538272448
Name:RIVERA SANTIAGO, KIMBERLY (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:RIVERA SANTIAGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AQ13 CALLE RIO SONADOR
Mailing Address - Street 2:VALLE VERDE
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-3259
Mailing Address - Country:US
Mailing Address - Phone:787-640-6611
Mailing Address - Fax:787-395-7451
Practice Address - Street 1:73 CALLE SANTA CRUZ
Practice Address - Street 2:EDIF. MEDICO STA. CRUZ SUITE 314
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6910
Practice Address - Country:US
Practice Address - Phone:787-787-0117
Practice Address - Fax:787-395-7451
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14720208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI-24772Medicare UPIN
PRDT299AMedicare PIN