Healthcare Provider Details

I. General information

NPI: 1821233735
Provider Name (Legal Business Name): CARLOS M RIVERA-CABAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2008
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 AVE TITO CASTRO STE 602 TORRE MEDICA SAN LUCAS
PONCE PR
00716-4721
US

IV. Provider business mailing address

909 AVE TITO CASTRO STE 602 TORRE MEDICA SAN LUCAS
PONCE PR
00716-4721
US

V. Phone/Fax

Practice location:
  • Phone: 787-651-1429
  • Fax: 787-651-1430
Mailing address:
  • Phone: 787-651-1429
  • Fax: 787-651-1430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME132528
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number23707
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: