Provider Demographics
NPI:1417038969
Name:RIVERA, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:
Other - Last Name:RIVERA QUILES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00739 0459
Mailing Address - Country:UM
Mailing Address - Phone:787-739-6688
Mailing Address - Fax:787-739-6688
Practice Address - Street 1:AVE. EL JIBARO HOSPITAL MENONITA CIDRA
Practice Address - Street 2:OFICINA 105
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739-0459
Practice Address - Country:US
Practice Address - Phone:787-739-6688
Practice Address - Fax:787-739-6688
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9611208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE-75369Medicare UPIN
PR8-2345Medicare ID - Type Unspecified
PR8-2345Medicare PIN