Provider Demographics
NPI:1316055692
Name:RIVERA DE LOS RIOS, ANGEL LUIS (MD)
Entity type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:LUIS
Last Name:RIVERA DE LOS RIOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4179
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-4179
Mailing Address - Country:US
Mailing Address - Phone:787-833-5150
Mailing Address - Fax:787-833-5574
Practice Address - Street 1:CALLE BASORA # 60 N
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00681-4179
Practice Address - Country:US
Practice Address - Phone:787-833-5150
Practice Address - Fax:787-833-5574
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3795174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist