Provider Demographics
NPI:1518730225
Name:RIVERA, EDWIN LOPEZ SR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:LOPEZ
Last Name: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 1127
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-1127
Mailing Address - Country:US
Mailing Address - Phone:787-562-5325
Mailing Address - Fax:
Practice Address - Street 1:CARR 417 R 195 INT
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-1127
Practice Address - Country:US
Practice Address - Phone:787-562-5325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-03
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23665208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice