Healthcare Provider Details

I. General information

NPI: 1548476245
Provider Name (Legal Business Name): CARMEN VIVIAN RIVERA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#2 DRIVE CAIMITAL BAJO
AGUADILLA PR
00605-0000
US

IV. Provider business mailing address

CALLE LIGHTHOUSE # 131 BASE RAMEY
AGUADILLA PR
00603-0000
US

V. Phone/Fax

Practice location:
  • Phone: 787-891-3070
  • Fax: 787-882-4605
Mailing address:
  • Phone: 787-646-0595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number008085
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: