MEDICARE: DR. RENATO RIVERA

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	2080P0214X	Pediatric Pulmonology Physician	6907	PR

General Provider Information

NPI Number	:	1992787634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RENATO RIVERA

Provider Business Mailing Address
First Line	:	PO BOX 9442
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00726-9442
Country	:	US
Telephone Number	:	787-746-3534
Fax Number	:	787-258-8129

Provider Business Practice Location Address
First Line	:	AVE DEGETAU
Second Line	:	SAN ALFONSO
City	:	CAGUAS
State	:	PR
Zip	:	00725-5819
Country	:	US
Telephone Number	:	787-746-3534
Fax Number	:	787-258-8129

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

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	04/05/2024

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