Provider Demographics
NPI:1518089416
Name:REYMUNDI-RIVERA, RAUL E (MD)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:E
Last Name:REYMUNDI-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:FF12 CALLE MAGNOLIA
Mailing Address - Street 2:BORINQUEN GARDENS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6306
Mailing Address - Country:US
Mailing Address - Phone:787-720-2689
Mailing Address - Fax:787-767-3968
Practice Address - Street 1:BO. MONACILLOS
Practice Address - Street 2:HOSPITAL INDUSTRIAL- CENTRO MEDICO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936
Practice Address - Country:US
Practice Address - Phone:787-754-2525
Practice Address - Fax:787-767-3968
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR25282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR9582683OtherFEDERAL NARCOTICS LICENSE
PR5634OtherSTATE LICENSE
PR04766DM-2OtherSTATE NARCOTICS LICENSE