Provider Demographics
NPI:1184859001
Name:RIVERA, JUAN OSCAR (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:OSCAR
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 1:76 CALLE TENERIFE
Mailing Address - Street 2:URB. SULTANA
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-1462
Mailing Address - Country:US
Mailing Address - Phone:787-422-2059
Mailing Address - Fax:787-856-5326
Practice Address - Street 1:76 CALLE TENERIFE
Practice Address - Street 2:URB. SULTANA
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-1462
Practice Address - Country:US
Practice Address - Phone:787-422-2059
Practice Address - Fax:787-856-5326
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17554208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice