Provider Demographics
NPI:1548465479
Name:RIVERA, RAFAEL ANTONIO SR (MD)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:ANTONIO
Last Name:RIVERA
Suffix:SR
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:CALLE 4 W 17 VILLA NUEVA
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727
Mailing Address - Country:US
Mailing Address - Phone:787-746-5651
Mailing Address - Fax:
Practice Address - Street 1:EDIFICIO GAUTIER BENITEZ
Practice Address - Street 2:2ND PISO, CALLE GAUTIER BENITEZ
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-607-1927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4468208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR25478OtherSSS
PR63514OtherCRUZ AZUL