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General NPI Number Information
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NPI Number | 1376265645
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Entity Type | Individual
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Provider Name | HIRAM RIVERA DE LEON PA
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Gender | Male
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Dates
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Enumeration Date | 09/14/2022
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Last Update Date | 10/07/2022
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Provider Practice Location Address
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Address Line | 222B CALLE 4
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City | GUAYAMA
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State | PR
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Zip | 00784-5939
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Country | US
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Telephone | 787-866-4005
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1784
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City | GUAYAMA
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State | PR
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Zip | 00785-1784
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Country | US
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Telephone | 787-362-7714
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1434
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License Number State | PR
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