Healthcare Provider Details

I. General information

NPI: 1801856026
Provider Name (Legal Business Name): ANGEL B RIVERA SANTOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 04/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2275 PONCE BY PASS CARIBBEAN MEDICAL CENTER
PONCE PR
00717-1380
US

IV. Provider business mailing address

PO BOX 494
MERCEDITA PR
00715-0494
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-1455
  • Fax: 787-848-4657
Mailing address:
  • Phone: 787-840-1455
  • Fax: 787-848-4657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number12002
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: