Healthcare Provider Details

I. General information

NPI: 1285283317
Provider Name (Legal Business Name): ROBERT RIVERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ROBERT WILSON RIVERA MT

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR. PR 173, KM 6, HM5, SECTOR SAN JOSE, BO. RABANAL
CIDRA PR
00739
US

IV. Provider business mailing address

P.O. BOX 459
CIDRA PR
00739
US

V. Phone/Fax

Practice location:
  • Phone: 787-520-7390
  • Fax: 787-520-7108
Mailing address:
  • Phone: 787-520-7390
  • Fax: 787-520-7108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number9611
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: