Healthcare Provider Details

I. General information

NPI: 1952665689
Provider Name (Legal Business Name): MIGUEL ANGEL RIVERA-VIERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE 65 INFANTERIA HOSPITAL FEDERICO TRILLA
CAROLINA PR
00987-7627
US

IV. Provider business mailing address

AVE BORINQUEN 2020, BARRIO OBRERO HEALTHPROMED
SAN JUAN PR
00915
US

V. Phone/Fax

Practice location:
  • Phone: 787-757-1800
  • Fax:
Mailing address:
  • Phone: 787-268-4171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number18782
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: