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General NPI Number Information
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NPI Number | 1124554449
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Entity Type | Individual
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Provider Name | IVAN AUGUSTO RIVERA NAZARIO MD
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Gender | Male
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Dates
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Enumeration Date | 05/05/2017
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Last Update Date | 08/01/2024
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Provider Practice Location Address
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Address Line | HOSPITAL MUNICIPAL DE SAN JUAN BARRIO MONACILLO CENTRO MEDICO DE PUERTO RICO
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City | SAN JUAN
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State | PR
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Zip | 00928
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Country | US
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Telephone | 787-480-0000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 191811
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City | SAN JUAN
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State | PR
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Zip | 00919-1811
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Country | US
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Telephone | 787-763-4149
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 21051
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License Number State | PR
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