Provider Demographics
NPI:1134116668
Name:RIVERA-COLON, RAFAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:
Last Name:RIVERA-COLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAFAEL
Other - Middle Name:
Other - Last Name:RIVERA-COLON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 8939
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-8939
Mailing Address - Country:US
Mailing Address - Phone:787-743-2887
Mailing Address - Fax:787-747-2945
Practice Address - Street 1:AV. LAS AMERICAS
Practice Address - Street 2:BU 2 URB. BAIROA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-743-2887
Practice Address - Fax:787-747-2945
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6729208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC77605Medicare UPIN