MEDICARE: CRISTOBAL RIVERA RAMOS M. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	28436-R	PR
2	207R00000X	Internal Medicine Physician	19,011	PR

General Provider Information

NPI Number	:	1235411463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTOBAL RIVERA RAMOS M. D.

Provider Business Mailing Address
First Line	:	URB VILLA DEL SOL
Second Line	:	A-8
City	:	JUANA DIAZ
State	:	PR
Zip	:	00795
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PLZ SANTA ISABEL
Second Line	:	#15
City	:	SANTA ISABEL
State	:	PR
Zip	:	00757-4002
Country	:	US
Telephone Number	:	787-929-5882
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2011
Last Update Date	:	10/07/2015

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