Provider Demographics
NPI:1750387411
Name:RIVERA, RAFAEL ANGEL (MD)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:ANGEL
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:29 CALLE WASHINGTON
Mailing Address - Street 2:STE 809
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1503
Mailing Address - Country:US
Mailing Address - Phone:787-724-5003
Mailing Address - Fax:787-721-7639
Practice Address - Street 1:29 CALLE WASHINGTON
Practice Address - Street 2:STE 809
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1503
Practice Address - Country:US
Practice Address - Phone:787-724-5003
Practice Address - Fax:787-721-7639
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR3545207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD33468Medicare UPIN
PR024893Medicare ID - Type Unspecified