Provider Demographics
NPI:1720010960
Name:RIVERA-CARRION, RUBEN (MD)
Entity Type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:
Last Name:RIVERA-CARRION
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 1:3006 AVE EMILIO FAGOT
Mailing Address - Street 2:SUITE # 2
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-3612
Mailing Address - Country:US
Mailing Address - Phone:787-841-3954
Mailing Address - Fax:787-844-0820
Practice Address - Street 1:3006 AVE EMILIO FAGOT
Practice Address - Street 2:SUITE # 2
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-3612
Practice Address - Country:US
Practice Address - Phone:787-841-3954
Practice Address - Fax:787-844-0820
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR75442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR27526OtherTRIPLE SSS PROVIDER NUMBE
PR067718OtherBLUE SHIELD/BLUE CROSS-PR
PR8-1993Medicare ID - Type UnspecifiedMD-PROVIDER NUMBER