Healthcare Provider Details

I. General information

NPI: 1417936741
Provider Name (Legal Business Name): MIGUEL RIVERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 09/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CLINICA YAGUEZ CALLE RAMON VALDEZ #71
MAYAGUEZ PR
00681
US

IV. Provider business mailing address

PO BOX 3008 MARINA STATION
MAYAGUEZ PR
00681-3008
US

V. Phone/Fax

Practice location:
  • Phone: 787-833-0885
  • Fax:
Mailing address:
  • Phone: 787-833-0885
  • Fax: 787-831-2177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5895
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: