Healthcare Provider Details

I. General information

NPI: 1417273145
Provider Name (Legal Business Name): RIVERA ORTHOPEDICS AND SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2010
Last Update Date: 04/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 CALLE CONVENTO
SAN JUAN PR
00912-3205
US

IV. Provider business mailing address

STREET JUAN C BORBON SUITE 67 395
GUAYNABO PR
00969-5375
US

V. Phone/Fax

Practice location:
  • Phone: 787-724-8919
  • Fax:
Mailing address:
  • Phone: 787-627-0588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number15637
License Number StatePR

VIII. Authorized Official

Name: DR. ALBERTO R. RIVERA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-627-0588