Provider Demographics
NPI:1447925649
Name:RIVERA HERNANDEZ, SHIRLEY MARIE (MD)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:MARIE
Last Name:RIVERA HERNANDEZ
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:HC 1 BOX 4535
Mailing Address - Street 2:
Mailing Address - City:CIALES
Mailing Address - State:PR
Mailing Address - Zip Code:00638-9691
Mailing Address - Country:US
Mailing Address - Phone:787-231-9025
Mailing Address - Fax:
Practice Address - Street 1:CARR 149 KM 18.2 BARRIO PESA SECTOR CAPILLA INTERIOR
Practice Address - Street 2:
Practice Address - City:CIALES,
Practice Address - State:PR
Practice Address - Zip Code:00638-0063
Practice Address - Country:US
Practice Address - Phone:787-231-9025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22474208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice