MEDICARE: ANIBAL MIGUEL MARIN-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	22603	PR

General Provider Information

NPI Number	:	1760133201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANIBAL MIGUEL MARIN-RIVERA MD

Provider Business Mailing Address
First Line	:	PO BOX 6666
Second Line	:
City	:	MAYAGUEZ
State	:	PR
Zip	:	00681-6666
Country	:	US
Telephone Number	:	787-397-3222
Fax Number	:

Provider Business Practice Location Address
First Line	:	URB RIO HONDO 2 CALLE RIO JAJOME AK-16
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00691
Country	:	US
Telephone Number	:	787-397-3222
Fax Number	:

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

Provider Enumeration Date	:	01/17/2022
Last Update Date	:	03/30/2022

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