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General NPI Number Information
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NPI Number | 1699516062
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Entity Type | Individual
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Provider Name | CARLOS M RIVERA PHYSICIAN ASSISTANT
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Gender | Male
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Dates
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Enumeration Date | 06/01/2024
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Last Update Date | 06/01/2024
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Provider Practice Location Address
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Address Line | 75 CALLE SIMON BOLIVAR
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City | MAYAGUEZ
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State | PR
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Zip | 00680-4506
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Country | US
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Telephone | 939-228-4771
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Fax |
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Provider Business Mailing Address
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Address Line | 747 ISLAND ST
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City | DAVENPORT
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State | FL
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Zip | 33897-5836
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Country | US
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Telephone | 939-228-4771
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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 | 826-P.A
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License Number State | PR
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