MEDICARE: DR. RAQUEL M RIVERA CRUZ 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	207Q00000X	Family Medicine Physician	51856	AL
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207Q00000X	Family Medicine Physician	E-15764	AR
4	207Q00000X	Family Medicine Physician	R76899	AZ

General Provider Information

NPI Number	:	1649700337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAQUEL M RIVERA CRUZ MD

Provider Business Mailing Address
First Line	:	PO BOX 2650
Second Line	:
City	:	PINE BLUFF
State	:	AR
Zip	:	71613-2650
Country	:	US
Telephone Number	:	870-541-7211
Fax Number	:	870-541-4297

Provider Business Practice Location Address
First Line	:	1801 W 40TH AVE STE 6A
Second Line	:
City	:	PINE BLUFF
State	:	AR
Zip	:	71603-6963
Country	:	US
Telephone Number	:	870-541-7393
Fax Number	:	870-541-0109

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

Provider Enumeration Date	:	06/14/2017
Last Update Date	:	03/13/2026

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