Healthcare Provider Details

I. General information

NPI: 1164550307
Provider Name (Legal Business Name): STEVEN RIVAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/21/2022
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#410 AVE. GENERAL VALERO TORRE MDICA HIMA SAN PABLO FAJARDO SUITE # 305
FAJARDO PR
00738
US

IV. Provider business mailing address

PO BOX 975
TRUJILLO ALTO PR
00977-0975
US

V. Phone/Fax

Practice location:
  • Phone: 787-801-1675
  • Fax: 787-801-1677
Mailing address:
  • Phone: 787-801-1675
  • Fax: 787-801-1677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number13609
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number13609
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: