Basic Information
| Provider Information | |||||||||
| NPI: | 1144993700 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIVERA SANTIAGO | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | AIME | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | CARRETERA #22 HOSPITAL ONCOLOGICO | ||||||||
| Address2: | DR. ISAAC GONZALEZ MARTINEZ | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877634149 | ||||||||
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| Practice Location | |||||||||
| Address1: | BO MONACILLOS #150 AVENIDA AMERICO MIRANDA | ||||||||
| Address2: | |||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009350001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877634149 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2021 | ||||||||
| LastUpdateDate: | 08/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | PR | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208D00000X | 22950 | PR | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.