Healthcare Provider Details

I. General information

NPI: 1780712216
Provider Name (Legal Business Name): PEDRO LUIS RIVERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DR. VEVE STREET #59 SECOND LEVEL
SAN GERMAN PR
00683
US

IV. Provider business mailing address

PO BOX 227
SAN GERMAN PR
00683-0227
US

V. Phone/Fax

Practice location:
  • Phone: 787-892-5265
  • Fax: 787-892-5265
Mailing address:
  • Phone: 787-892-5265
  • Fax: 787-892-5265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number9810
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: