Provider Demographics
NPI:1467400804
Name:RIVERA PEREZ, CARMEN (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:
Last Name:RIVERA PEREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 CALLE HIPODROMO APT 1605
Mailing Address - Street 2:HIPODROMO 603
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-2146
Mailing Address - Country:US
Mailing Address - Phone:787-725-8484
Mailing Address - Fax:787-848-0318
Practice Address - Street 1:1902 CALLE LOIZA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00911-1891
Practice Address - Country:US
Practice Address - Phone:787-616-7626
Practice Address - Fax:787-848-0318
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8539208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0080015Medicare PIN