Healthcare Provider Details

I. General information

NPI: 1174380307
Provider Name (Legal Business Name): KEMUEL MARTINEZ RIVERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 03/04/2024
Certification Date: 03/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 CALLE MUNOZ RIVERA W
RINCON PR
00677-2127
US

IV. Provider business mailing address

VILLA ALBA CALLE 10, I - 8
SABANA GRANDE PR
00637-1757
US

V. Phone/Fax

Practice location:
  • Phone: 787-823-5500
  • Fax:
Mailing address:
  • Phone: 939-253-2602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number038282
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: