MEDICARE: DR. JUAN CARLOS CARLOS 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	207V00000X	Obstetrics & Gynecology Physician	M4476	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	M4476	OTHER	TX	LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528137692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN CARLOS CARLOS RIVERA M.D.

Provider Business Mailing Address
First Line	:	5419 SOUTH MCCOLL ROAD
Second Line	:
City	:	EDINBURG
State	:	TX
Zip	:	78539-9183
Country	:	US
Telephone Number	:	956-630-0090
Fax Number	:	956-630-0099

Provider Business Practice Location Address
First Line	:	5419 SOUTH MCCOLL ROAD
Second Line	:
City	:	EDINBURG
State	:	TX
Zip	:	78539-9183
Country	:	US
Telephone Number	:	956-630-0090
Fax Number	:	956-630-0099

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	12/14/2010

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Directions to “ DR. JUAN CARLOS CARLOS RIVERA M.D.” Practice Location

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