Provider Demographics
NPI:1629140926
Name:OMS RIVERA, RAFAEL L (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:L
Last Name:OMS RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2225 EDIF PARRA
Mailing Address - Street 2:PONCE BY PASS SUITE 301
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1321
Mailing Address - Country:US
Mailing Address - Phone:787-848-4937
Mailing Address - Fax:787-848-9289
Practice Address - Street 1:2225 EDIF PARRA
Practice Address - Street 2:PONCE BY PASS SUITE 301
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1321
Practice Address - Country:US
Practice Address - Phone:787-848-4937
Practice Address - Fax:787-848-9289
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR8306208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7310234OtherHUMANA
PR602014OtherMMM
PR066513OtherCRUZ AZUL
PR2803OtherMCS
PR7310234OtherHUMANA
PRB76116Medicare UPIN