Provider Demographics
NPI:1518695196
Name:RIVERA, CARLOS OMAR (BSN)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:OMAR
Last Name:RIVERA
Suffix:
Gender:M
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 01 BOX 6283
Mailing Address - Street 2:
Mailing Address - City:OROCOVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00720
Mailing Address - Country:US
Mailing Address - Phone:939-246-3006
Mailing Address - Fax:
Practice Address - Street 1:CARR 143 KM 35.9 INT
Practice Address - Street 2:BO BAUTA ABAJO SEC MATRULLAS
Practice Address - City:OROCOVIS
Practice Address - State:PR
Practice Address - Zip Code:00720
Practice Address - Country:US
Practice Address - Phone:939-246-3006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)