Doctor Name: | LILLIAM WALESKA RIVERA BERMUDEZ |
NPI Number: | 1730156878 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | 15490 |
Business Practice Address: | 420 Diamante, Urb Brisas De Laurel Coto Laurel, PR - 007802217 |
Business Phone Number: | 7872606116 |
Business Fax Number: | 7872606116 |
Mailing Address: | 420 Diamante, Urb Brisas De Laurel, COTO LAUREL |
State: | PR |
Postal Code: | 007802217 |
Phone Number: | 7872606116 |
Fax Number: | 7872606116 |
NPI Enumeration Date: | 03/08/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 15490 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PR |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |