MEDICARE: MARCO A. 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	174400000X	Specialist	6683	PR

General Provider Information

NPI Number	:	1821052291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCO A. RIVERA M.D.

Provider Business Mailing Address
First Line	:	1051 CALLE 3 SE
Second Line	:	MEDICAL CENTER PLAZA 610, LA RIVIERA
City	:	SAN JUAN
State	:	PR
Zip	:	00921-3000
Country	:	US
Telephone Number	:	787-775-2412
Fax Number	:	787-781-1110

Provider Business Practice Location Address
First Line	:	1051 CALLE 3 SE
Second Line	:	MEDICAL CENTER PLAZA 610, LA RIVIERA
City	:	SAN JUAN
State	:	PR
Zip	:	00921-3000
Country	:	US
Telephone Number	:	787-775-2412
Fax Number	:	787-781-1110

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

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	07/08/2007

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