Healthcare Provider Details

I. General information

NPI: 1104669506
Provider Name (Legal Business Name): WILLIAM JOEL RIVERA CARRERO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 06/14/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSPITAL BUEN SAMARITANO CARR. EST. PR-460, KM. 0.2 BO. CAIMITAL BAJO AGUADILLA PUERTO RICO, 00603
AGUADILLA PR
00603
US

IV. Provider business mailing address

8309 KELSALL DR # 32823
ORLANDO FL
32832-6322
US

V. Phone/Fax

Practice location:
  • Phone: 787-658-0000
  • Fax: 787-819-0805
Mailing address:
  • Phone: 407-404-1292
  • 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 State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: