Healthcare Provider Details

I. General information

NPI: 1164467171
Provider Name (Legal Business Name): EDGARDO RIVERA HERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COND TORRE AUXILIO MUTUO 735 AVE PONCE DE LEON OFICINA 704
SAN JUAN PR
00917-5029
US

IV. Provider business mailing address

COND TORRE AUXILIO MUTUO 735 AVE PONCE DE LEON OFICINA 704
SAN JUAN PR
00917-5029
US

V. Phone/Fax

Practice location:
  • Phone: 787-765-8620
  • Fax: 787-767-6138
Mailing address:
  • Phone: 787-765-8620
  • Fax: 787-767-6138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number12201
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number12201
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: