Healthcare Provider Details

I. General information

NPI: 1477344562
Provider Name (Legal Business Name): ANGEL LUIS MAISONET RIVERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2025
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 CAMBRIDGE ST
BRIGHTON MA
02135-2907
US

IV. Provider business mailing address

1644 CALLE JOSE H CORA APT 102
SAN JUAN PR
00909-2823
US

V. Phone/Fax

Practice location:
  • Phone: 617-789-3000
  • Fax:
Mailing address:
  • Phone: 939-630-8105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: