Provider Demographics
NPI:1427181338
Name:RIVERA, CARLOS FRANCIS
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:FRANCIS
Last Name:RIVERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CARLOS
Other - Middle Name:FRANCIS
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:65 INFANTERIA #67
Mailing Address - Street 2:SUITE B-201
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-0084
Mailing Address - Country:US
Mailing Address - Phone:787-826-0932
Mailing Address - Fax:787-826-6082
Practice Address - Street 1:CARR 308 KM 6.1 SERENITY BY THE SEA
Practice Address - Street 2:APT BF2
Practice Address - City:RABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-0084
Practice Address - Country:US
Practice Address - Phone:787-238-5364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X
PR141PA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4513910001Medicare ID - Type UnspecifiedDURABLE MEDICAL EQUIPMENT