Healthcare Provider Details

I. General information

NPI: 1679458723
Provider Name (Legal Business Name): CLAUDIA MOREDA RIVERO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2025
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OFICINA 204 URB ATENAS E37 CALLE HERNANDEZ CARRION
MANATI PR
00674-4622
US

IV. Provider business mailing address

PO BOX 43
MANATI PR
00674-0043
US

V. Phone/Fax

Practice location:
  • Phone: 787-621-3270
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: CLAUDIA M MOREDA RIVERO
Title or Position: MEMBER
Credential:
Phone: 787-621-3700