Provider Demographics
NPI:1073657995
Name:RIVERA, ANGEL L (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:L
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 1:1751 CALLE ALCALA
Mailing Address - Street 2:URB. COLLEGE PARK
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-4335
Mailing Address - Country:US
Mailing Address - Phone:787-763-4569
Mailing Address - Fax:
Practice Address - Street 1:1751 CALLE ALCALA
Practice Address - Street 2:URB. COLLEGE PARK
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-4335
Practice Address - Country:US
Practice Address - Phone:787-763-4569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3118174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist