Healthcare Provider Details

I. General information

NPI: 1700999471
Provider Name (Legal Business Name): PEDRO ANTONIO RIVERA CABALLERO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 12/31/2020
Certification Date: 12/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE FERNANEZ JUNCOS EDIF JESUS T PINERO
CAROLINA PR
00985
US

IV. Provider business mailing address

VALLES DEL LAGO 1069 CALLE GUAJATACA
CAGUAS PR
00725
US

V. Phone/Fax

Practice location:
  • Phone: 787-626-3322
  • Fax:
Mailing address:
  • Phone: 787-647-9641
  • Fax: 787-279-1250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number16400
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: