Provider Demographics
NPI:1649859448
Name:DRA LINA N RIVERA RIVERA PSC
Entity type:Organization
Organization Name:DRA LINA N RIVERA RIVERA PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LINA
Authorized Official - Middle Name:NANETTE
Authorized Official - Last Name:RIVERA RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-918-2703
Mailing Address - Street 1:185 ALTOS DE CIUDAD JARDIN
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-9101
Mailing Address - Country:US
Mailing Address - Phone:787-918-2703
Mailing Address - Fax:
Practice Address - Street 1:36 CALLE MARTINEZ STE 1
Practice Address - Street 2:
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777-3671
Practice Address - Country:US
Practice Address - Phone:787-918-2703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-07
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR038896000Medicaid