Provider Demographics
NPI:1003884065
Name:RIOS, WALDEMAR CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:WALDEMAR
Middle Name:CHARLES
Last Name:RIOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:400 AVE DOMENECH
Mailing Address - Street 2:SUITE 607
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3710
Mailing Address - Country:US
Mailing Address - Phone:787-250-0084
Mailing Address - Fax:787-772-7731
Practice Address - Street 1:400 AVE DOMENECH
Practice Address - Street 2:SUITE 607
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3710
Practice Address - Country:US
Practice Address - Phone:787-250-0084
Practice Address - Fax:787-250-2181
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14760207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR212899OtherPREFERRED HEALTH
PR22925OtherTRIPLE S
PR300129OtherMMM
PRPE4854OtherPALIC
PR100679OtherCRUZ AZUL
PR2879OtherPREFERRED MEDICARE CHOICE
PR9180625OtherHUMANA
PR9180625OtherHUMANA
PRI26992Medicare UPIN