Provider Demographics
NPI:1093888471
Name:CENTRO PODIATRICO DR. RIVERA ESQUERDO PSC
Entity Type:Organization
Organization Name:CENTRO PODIATRICO DR. RIVERA ESQUERDO PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILDREDO
Authorized Official - Middle Name:R
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:787-655-4023
Mailing Address - Street 1:PO BOX 70005
Mailing Address - Street 2:PMP 293
Mailing Address - City:FUJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738
Mailing Address - Country:US
Mailing Address - Phone:787-655-4023
Mailing Address - Fax:787-655-4024
Practice Address - Street 1:TORRE SAN PABLO DEL ESTE SUITE 204
Practice Address - Street 2:HOSPITAL HIMA SAN PABLO DEL ESTE
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-655-4023
Practice Address - Fax:787-655-4024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T26840Medicare UPIN
0048022Medicare ID - Type Unspecified