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General NPI Number Information
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NPI Number | 1093888471
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Entity Type | Organization
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Legal Business Name | CENTRO PODIATRICO DR. RIVERA ESQUERDO PSC
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | TORRE SAN PABLO DEL ESTE SUITE 204 HOSPITAL HIMA SAN PABLO DEL ESTE
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City | FAJARDO
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State | PR
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Zip | 00738
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Country | US
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Telephone | 787-655-4023
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Fax | 787-655-4024
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Provider Business Mailing Address
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Address Line | PO BOX 70005 PMP 293
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City | FUJARDO
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State | PR
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Zip | 00738
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Country | US
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Telephone | 787-655-4023
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Fax | 787-655-4024
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILDREDO R RIVERA
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Credential | DPM
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Telephone | 787-655-4023
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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