Provider Demographics
NPI:1245283431
Name:RIVERA, ELVIN GERARDO (MD)
Entity type:Individual
Prefix:MR
First Name:ELVIN
Middle Name:GERARDO
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:ASHFORD AVE #1477
Mailing Address - Street 2:APT 501
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907
Mailing Address - Country:US
Mailing Address - Phone:787-728-4474
Mailing Address - Fax:787-725-2964
Practice Address - Street 1:29 WASHINGTON ST
Practice Address - Street 2:ASHFORD MEDICAL CENTER STE 709
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-725-2964
Practice Address - Fax:787-725-2964
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR12037207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
600509OtherMMM
10312037CAOtherGLOBAL HEALTH PLAN
220271OtherPREFERRED HEALTH PLAN
060280OtherCA
2490OtherAMERICAN HEALTH
SE4306OtherPALIC
9021OtherIMC
9120264OtherHUMANA HEALTH PLAN
88600RIOtherSSS
10312037CAOtherGLOBAL HEALTH PLAN
9120264OtherHUMANA HEALTH PLAN