Provider Demographics
NPI:1619138344
Name:RIVERA SANTIAGO, EFREN (MD)
Entity Type:Individual
Prefix:
First Name:EFREN
Middle Name:
Last Name:RIVERA SANTIAGO
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:F4 AVE PRINCIPAL
Mailing Address - Street 2:URB BARALT
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738
Mailing Address - Country:US
Mailing Address - Phone:787-860-5002
Mailing Address - Fax:787-655-9021
Practice Address - Street 1:F4 AVE PRINCIPAL
Practice Address - Street 2:URB BARALT
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-860-5002
Practice Address - Fax:787-655-9021
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17155208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice