Healthcare Provider Details

I. General information

NPI: 1740542695
Provider Name (Legal Business Name): CLINICA ESPECIALIZADA DR. ANGEL E. RIVERA NEGRON, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 06/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. 140 KM. 68.1 BO. PUEBLO
BARCELONETA PR
00617
US

IV. Provider business mailing address

P.O. BOX 1745
BARCELONETA PR
00617-1745
US

V. Phone/Fax

Practice location:
  • Phone: 787-846-5094
  • Fax: 787-846-5962
Mailing address:
  • Phone: 787-846-5094
  • Fax: 787-846-5962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number13933
License Number StatePR

VII. Legacy identifiers

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

# 1
Identifier1902825334
Identifier TypeOTHER
Identifier State
Identifier IssuerNPI

VIII. Authorized Official

Name: MR. ANGEL E. RIVERA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-846-5094