Basic Information
| Provider Information | |||||||||
| NPI: | 1003131996 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIVERA-BURGOS | ||||||||
| FirstName: | ILEANA | ||||||||
| MiddleName: | IVETTE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 70344 | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009368344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7874802700 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 150 AVE AMERICO MIRANDA | ||||||||
| Address2: | AREA DE CENTRO MEDICO METROPOLITANO BO MONACILLOS | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877634149 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2010 | ||||||||
| LastUpdateDate: | 01/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 33578R | PR | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 133N00000X | 1565 | PR | N | Dietary & Nutritional Service Providers | Nutritionist | 390200000X | 21954 | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 21954 | PR | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.