Provider Demographics
NPI:1417927237
Name:RIVERA, TOMAS HUMBERTO (MD)
Entity Type:Individual
Prefix:
First Name:TOMAS
Middle Name:HUMBERTO
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 1:251 CALLE LA PAZ
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-2940
Mailing Address - Country:US
Mailing Address - Phone:787-868-9010
Mailing Address - Fax:787-252-5013
Practice Address - Street 1:251 CALLE LA PAZ
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-2940
Practice Address - Country:US
Practice Address - Phone:787-868-9010
Practice Address - Fax:787-252-5013
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5574207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC79566Medicare UPIN