Healthcare Provider Details

I. General information

NPI: 1396232591
Provider Name (Legal Business Name): ERICK MANUEL RIVERA-GRANA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 CALLE UN
PONCE PR
00730-3749
US

IV. Provider business mailing address

3181 SW SAM JACKSON PARK RD
PORTLAND OR
97239-3011
US

V. Phone/Fax

Practice location:
  • Phone: 787-460-6568
  • Fax:
Mailing address:
  • Phone: 503-494-3000
  • Fax: 503-494-4286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD214392
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number22299
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code207WX0108X
TaxonomyUveitis and Ocular Inflammatory Disease (Ophthalmology) Physician
License Number22299
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: