Provider Demographics
NPI:1164468922
Name:RIVERA, CLARA L (MD)
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:L
Last Name:RIVERA
Suffix:
Gender:F
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:BOX 872
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719
Mailing Address - Country:US
Mailing Address - Phone:787-869-8392
Mailing Address - Fax:787-869-4211
Practice Address - Street 1:CARR 164 KM 5 EL DESVIO BO ACHIOTE
Practice Address - Street 2:
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719
Practice Address - Country:US
Practice Address - Phone:787-869-4211
Practice Address - Fax:787-869-4211
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8290208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
83331OtherSSS
E43434Medicare UPIN
83331OtherSSS