Provider Demographics
NPI:1548476245
Name:RIVERA, CARMEN VIVIAN (MD)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:VIVIAN
Last Name:RIVERA
Suffix:
Gender:F
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 LIGHTHOUSE # 131
Mailing Address - Street 2:BASE RAMEY
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-0000
Mailing Address - Country:US
Mailing Address - Phone:787-646-0595
Mailing Address - Fax:
Practice Address - Street 1:#2 DRIVE
Practice Address - Street 2:CAIMITAL BAJO
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00605-0000
Practice Address - Country:US
Practice Address - Phone:787-891-3070
Practice Address - Fax:787-882-4605
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR008085251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management