Healthcare Provider Details

I. General information

NPI: 1750387411
Provider Name (Legal Business Name): RAFAEL ANGEL RIVERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 CALLE WASHINGTON STE 809
SAN JUAN PR
00907-1503
US

IV. Provider business mailing address

29 CALLE WASHINGTON STE 809
SAN JUAN PR
00907-1503
US

V. Phone/Fax

Practice location:
  • Phone: 787-724-5003
  • Fax: 787-721-7639
Mailing address:
  • Phone: 787-724-5003
  • Fax: 787-721-7639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number3545
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: