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General NPI Number Information
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NPI Number | 1972576049
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Entity Type | Individual
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Provider Name | EDGAR RIVERA MARTINEZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/09/2006
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Last Update Date | 11/04/2011
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Provider Practice Location Address
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Address Line | CALLE JOSE C VAZQUEZ EDIFICIO PROFESIONAL OFICINA 202 HOSPITAL MENONITA
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City | AIBONITO
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State | PR
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Zip | 00705
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Country | US
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Telephone | 787-735-7110
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Fax | 787-991-3041
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Provider Business Mailing Address
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Address Line | PO BOX 2300 PMB 21
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City | AIBONITO
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State | PR
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Zip | 00705-2300
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Country | US
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Telephone | 787-735-7110
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Fax | 787-991-3041
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 15031
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License Number State | PR
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