Provider Demographics
NPI:1053394783
Name:RIVERA, RUTH ESTHER (MD)
Entity type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:ESTHER
Last Name:RIVERA
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 872
Mailing Address - Street 2:
Mailing Address - City:CEIBA
Mailing Address - State:PR
Mailing Address - Zip Code:00735-0872
Mailing Address - Country:US
Mailing Address - Phone:787-885-3674
Mailing Address - Fax:787-885-3074
Practice Address - Street 1:262 AVE LAURO PINERO
Practice Address - Street 2:
Practice Address - City:CEIBA
Practice Address - State:PR
Practice Address - Zip Code:00735-2706
Practice Address - Country:US
Practice Address - Phone:787-885-3674
Practice Address - Fax:787-885-3674
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10921171100000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
F70585Medicare UPIN
PR83747Medicare ID - Type Unspecified