Healthcare Provider Details

I. General information

NPI: 1033305123
Provider Name (Legal Business Name): CAROLINE A RIVERA OLMO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CALLE MARGINAL KM 43.2 BO ALGARROBO
VEGA BAJA PR
00693-3844
US

IV. Provider business mailing address

PO BOX 212
BARCELONETA PR
00617-0212
US

V. Phone/Fax

Practice location:
  • Phone: 787-970-0708
  • Fax: 787-970-1105
Mailing address:
  • Phone: 787-404-2323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number16886
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: