Healthcare Provider Details

I. General information

NPI: 1558345181
Provider Name (Legal Business Name): ANIBAL SANDOZ RIVERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 01/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ADMINISTRACION DE SERVICIOS MEDICOS DE PR BOX 2129
SAN JUAN PR
00926
US

IV. Provider business mailing address

CASA 6 ROOSEVELT GARDENS
CEIBA PR
00735-0001
US

V. Phone/Fax

Practice location:
  • Phone: 787-777-3535
  • Fax: 787-251-4518
Mailing address:
  • Phone: 787-206-1072
  • Fax: 787-251-4518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number13325
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: