Provider Demographics
NPI:1073561569
Name:RIVERA VALE, PABLO (MD)
Entity Type:Individual
Prefix:DR
First Name:PABLO
Middle Name:
Last Name:RIVERA VALE
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 1:449 CALLE DEL PILAR
Mailing Address - Street 2:URB. LA MONSERRATE
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-4312
Mailing Address - Country:US
Mailing Address - Phone:787-877-7460
Mailing Address - Fax:787-877-7460
Practice Address - Street 1:PLAZA JAICOA
Practice Address - Street 2:SUITE #3
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-877-7460
Practice Address - Fax:787-877-7460
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14393208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI20768Medicare UPIN
PR0022807Medicare ID - Type Unspecified