Healthcare Provider Details

I. General information

NPI: 1720056799
Provider Name (Legal Business Name): YONATHAN RIVERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ST. TOMAS DAVILA #1
BARCELONETA PR
00617
US

IV. Provider business mailing address

P.O.BOX 359
BARCELONETA PR
00617
US

V. Phone/Fax

Practice location:
  • Phone: 787-846-6890
  • Fax:
Mailing address:
  • Phone: 787-846-6890
  • Fax: 787-846-5458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number15644
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: