Healthcare Provider Details

I. General information

NPI: 1700849817
Provider Name (Legal Business Name): CARLOS GILBERTO RIVERA BERMUDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 12/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 AVE DOMENECH BALDRICH
SAN JUAN PR
00918-3532
US

IV. Provider business mailing address

113 CALLE ALHELI, URB. SAN FRANCISCO
SAN JUAN PR
00927
US

V. Phone/Fax

Practice location:
  • Phone: 787-763-7423
  • Fax: 787-763-2039
Mailing address:
  • Phone: 787-758-6857
  • Fax: 787-764-9178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number4441
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: