Provider Demographics
NPI:1902800691
Name:RIVERA MORILLO, PEDRO D (MD)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:D
Last Name:RIVERA MORILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:PEDRO
Other - Middle Name:D
Other - Last Name:RIVERA MORILLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:AVE. LUIS MUNOZ MARIN A 8
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00726
Mailing Address - Country:UM
Mailing Address - Phone:787-744-1223
Mailing Address - Fax:787-745-1207
Practice Address - Street 1:AVENIDA MUNOZ MARIN A-8
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-744-1223
Practice Address - Fax:787-745-1207
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR65982080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF-92889Medicare UPIN