Provider Demographics
NPI:1609886969
Name:RIVERA, WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:
Last Name: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 1:244 CALLE PINO TANYOSHO
Mailing Address - Street 2:URB. LOS PINOS
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-5930
Mailing Address - Country:US
Mailing Address - Phone:787-884-6161
Mailing Address - Fax:787-884-6966
Practice Address - Street 1:244 CALLE PINO TANYOSHO
Practice Address - Street 2:URB. LOS PINOS
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-5930
Practice Address - Country:US
Practice Address - Phone:787-884-6161
Practice Address - Fax:787-884-6966
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14927208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH98267Medicare UPIN
PR22005Medicare ID - Type UnspecifiedMEDICARE NUMBER