MEDICARE: MRS. LOURDES MONTANO RIVERA MD

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	208D00000X	General Practice Physician	10081	PR

General Provider Information

NPI Number	:	1457460131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LOURDES MONTANO RIVERA MD

Provider Business Mailing Address
First Line	:	PO BOX 142427
Second Line	:
City	:	ARECIBO
State	:	PR
Zip	:	00614-2427
Country	:	US
Telephone Number	:	787-878-5746
Fax Number	:	787-878-5746

Provider Business Practice Location Address
First Line	:	AVE BARBOSA #66
Second Line	:	ARECIBO MEDICAL PLAZA SUITE 202
City	:	ARECIBO
State	:	PR
Zip	:	00612-0000
Country	:	US
Telephone Number	:	787-878-5746
Fax Number	:	787-878-5746

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	12/29/2011

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