Provider Demographics
NPI:1053384479
Name:RIOS MOTTA, MIRIAM E (MD)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:E
Last Name:RIOS MOTTA
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:PO BOX 19345
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-1345
Mailing Address - Country:US
Mailing Address - Phone:787-781-2402
Mailing Address - Fax:787-781-2464
Practice Address - Street 1:CENTRO INTERNACIONAL DE MERCADEO SUITE 306
Practice Address - Street 2:CARRETERA 165
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968
Practice Address - Country:US
Practice Address - Phone:787-781-2402
Practice Address - Fax:787-781-2464
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12159174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG65055Medicare UPIN
PR89405Medicare ID - Type Unspecified