Healthcare Provider Details

I. General information

NPI: 1861075970
Provider Name (Legal Business Name): OMAR RIVERA-ZAYAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 ZONA IND REPARADA 2
PONCE PR
00716-2347
US

IV. Provider business mailing address

PO BOX 7004
PONCE PR
00732-7004
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-2575
  • Fax:
Mailing address:
  • Phone: 787-840-2575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number24279
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: