Provider Demographics
NPI:1700849817
Name:RIVERA BERMUDEZ, CARLOS GILBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:GILBERTO
Last Name:RIVERA BERMUDEZ
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 1:113 CALLE ALHELI, URB. SAN FRANCISCO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927
Mailing Address - Country:US
Mailing Address - Phone:787-758-6857
Mailing Address - Fax:787-764-9178
Practice Address - Street 1:313 AVE DOMENECH
Practice Address - Street 2:BALDRICH
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3532
Practice Address - Country:US
Practice Address - Phone:787-763-7423
Practice Address - Fax:787-763-2039
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4441207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR26484Medicare PIN
PRE08199Medicare UPIN