Provider Demographics
NPI:1104823186
Name:RIVERA ALONSO, CARLOS A (OD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:A
Last Name:RIVERA ALONSO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 CALLE MARTINEZ
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-3636
Mailing Address - Country:US
Mailing Address - Phone:787-734-9090
Mailing Address - Fax:
Practice Address - Street 1:23 CALLE MARTINEZ
Practice Address - Street 2:
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777-3636
Practice Address - Country:US
Practice Address - Phone:787-734-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR232-0016152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1104823186OtherMAPFRE
PR58031RIOtherTRIPLE S
PR077057OtherCRUZ AZUL DE PUERTO RICO
PR19905OtherPROSSAM
PR1605OtherFIRST MEDICAL
PR215099OtherPREFFERED HEALTHCARE
PR660464923OtherCOSVIMED
PR6710023OtherHUMANA
PR890219OtherMEDICARE Y MUCHO MAS
PR58031RIOtherTRIPLE S
PR58031Medicare ID - Type Unspecified