Provider Demographics
NPI:1235116187
Name:RIVERA RODRIGUEZ, EZEQUIEL (MD)
Entity Type:Individual
Prefix:
First Name:EZEQUIEL
Middle Name:
Last Name:RIVERA RODRIGUEZ
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:PO BOX 360337
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-0337
Mailing Address - Country:US
Mailing Address - Phone:787-751-0373
Mailing Address - Fax:787-751-5517
Practice Address - Street 1:TORRE MEDICA AUXILIO MUTUO PONCEDELEON AVE
Practice Address - Street 2:STE 416
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00919
Practice Address - Country:US
Practice Address - Phone:787-751-0323
Practice Address - Fax:787-751-5517
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3015207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
93181Medicare ID - Type Unspecified
E09042Medicare UPIN