Basic Information
| Provider Information | |||||||||
| NPI: | 1699873950 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIVERA | ||||||||
| FirstName: | MARALEXIS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 73 CALLE COBANA | ||||||||
| Address2: | URB. LADERAS DE SAN JUAN | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009269322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7874743110 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | AVE. AMERICO MIRANDA | ||||||||
| Address2: | CENTRO MEDICO - HOSPITAL PEDIATRICO UNIVERSITARIO | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877773535 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0855X | 14078 | PR | X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 273R00000X | 14078 | PR | X | Hospital Units | Psychiatric Unit |
No ID Information.