MEDICARE: DR. RICARDO E RIVERA 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	2085U0001X	Diagnostic Ultrasound Physician	15838	PR
2	2085R0202X	Diagnostic Radiology Physician	15838	PR
3	2085N0700X	Neuroradiology Physician	15838	PR

General Provider Information

NPI Number	:	1255301214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICARDO E RIVERA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 190679
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00919-0679
Country	:	US
Telephone Number	:	787-705-5677
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 AVE DOMENECH
Second Line	:	SUITE 101
City	:	SAN JUAN
State	:	PR
Zip	:	00918-3710
Country	:	US
Telephone Number	:	787-705-5677
Fax Number	:

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

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	05/03/2023

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