Provider Demographics
NPI:1386654416
Name:RIVAS-HADDOCK, CARLOS MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:MANUEL
Last Name:RIVAS-HADDOCK
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:LUIS ALMANSA ST
Mailing Address - Street 2:#724 URBANIZACION FAIRVIEW
Mailing Address - City:RIO PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00926-7719
Mailing Address - Country:US
Mailing Address - Phone:787-755-5957
Mailing Address - Fax:787-755-5957
Practice Address - Street 1:LUIS ALMANSA ST
Practice Address - Street 2:#724 URBANIZACION FAIRVIEW
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00926-7719
Practice Address - Country:US
Practice Address - Phone:787-755-5957
Practice Address - Fax:787-755-5957
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR003494207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D48286Medicare UPIN