Healthcare Provider Details

I. General information

NPI: 1285570127
Provider Name (Legal Business Name): CARLOS RIVERA BARRETO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. SANTA MARIA # 7161
PONCE PR
00717-0770
US

IV. Provider business mailing address

COND SANTA MARIA # 7161
PONCE PR
00717-0770
US

V. Phone/Fax

Practice location:
  • Phone: 787-595-7380
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2412
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: