Provider Demographics
NPI:1619226578
Name:RIVERA MANZANO, KELVIN XAVIER (MD)
Entity Type:Individual
Prefix:DR
First Name:KELVIN
Middle Name:XAVIER
Last Name:RIVERA MANZANO
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:EC5 CALLE SAUCE
Mailing Address - Street 2:URBANIZACION LOS ALMENDROS
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-3417
Mailing Address - Country:US
Mailing Address - Phone:787-360-3945
Mailing Address - Fax:
Practice Address - Street 1:SAN JUAN CITY HOSPITAL
Practice Address - Street 2:PMB # 79
Practice Address - City:SAN JAUN
Practice Address - State:PR
Practice Address - Zip Code:00936
Practice Address - Country:US
Practice Address - Phone:787-480-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19015207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine