Provider Demographics
NPI:1215033493
Name:LEBRON RIVERA, ROBERTO (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:LEBRON 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 1:1050 LOS CORAZONES AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-7042
Mailing Address - Country:US
Mailing Address - Phone:787-834-5334
Mailing Address - Fax:787-833-6640
Practice Address - Street 1:1050 LOS CORAZONES AVE
Practice Address - Street 2:STE 102
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-7042
Practice Address - Country:US
Practice Address - Phone:787-834-5334
Practice Address - Fax:787-833-6640
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7328207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0084924EMedicare ID - Type Unspecified
PR0024175DMedicare ID - Type Unspecified
PR0022332EMedicare ID - Type Unspecified
PR0084993EMedicare ID - Type Unspecified
PR0084991EMedicare ID - Type Unspecified
D08462Medicare UPIN
PR0084992EMedicare ID - Type Unspecified