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General NPI Number Information
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NPI Number | 1174380307
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Entity Type | Individual
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Provider Name | KEMUEL MARTINEZ RIVERA
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Gender | Male
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Dates
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Enumeration Date | 03/04/2024
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Last Update Date | 03/04/2024
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Provider Practice Location Address
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Address Line | 28 CALLE MUNOZ RIVERA W
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City | RINCON
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State | PR
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Zip | 00677-2127
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Country | US
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Telephone | 787-823-5500
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Fax |
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Provider Business Mailing Address
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Address Line | VILLA ALBA CALLE 10, I - 8
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City | SABANA GRANDE
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State | PR
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Zip | 00637-1757
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Country | US
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Telephone | 939-253-2602
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 038282
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License Number State | PR
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