Provider Demographics
NPI:1467440164
Name:RIVERA RIVERA, OSVALDO SR (MD)
Entity Type:Individual
Prefix:
First Name:OSVALDO
Middle Name:
Last Name:RIVERA RIVERA
Suffix:SR
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:PO BOX 611
Mailing Address - Street 2:
Mailing Address - City:MERCEDITA
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0611
Mailing Address - Country:US
Mailing Address - Phone:787-842-4937
Mailing Address - Fax:787-840-1904
Practice Address - Street 1:COND PONCIA NA 9140 CALLE MARINO
Practice Address - Street 2:STE 203
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717
Practice Address - Country:US
Practice Address - Phone:787-842-4937
Practice Address - Fax:787-840-1904
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7550207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0080549Medicare ID - Type Unspecified
C77640Medicare UPIN