Provider Demographics
NPI:1053319616
Name:RIVERA, RAMON OBED (MD)
Entity Type:Individual
Prefix:MR
First Name:RAMON
Middle Name:OBED
Last Name:RIVERA
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 1661
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-1661
Mailing Address - Country:US
Mailing Address - Phone:787-265-0808
Mailing Address - Fax:787-265-0808
Practice Address - Street 1:AVENIDA CORAZONES #1065
Practice Address - Street 2:EDIFICIO MEDICO PROFESSIONAL #105
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-265-0808
Practice Address - Fax:787-265-0808
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7019207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
29722Medicare ID - Type Unspecified
D32360Medicare UPIN