Provider Demographics
NPI:1790867182
Name:DAVID-RIVERA, SALOMON JOSE (MD)
Entity Type:Individual
Prefix:MR
First Name:SALOMON
Middle Name:JOSE
Last Name:DAVID-RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:SALOMON
Other - Middle Name:JOSE
Other - Last Name:DAVID-RIVERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:ST ZAFINO #2118 VEB LAGO HORIZONTO
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780
Mailing Address - Country:US
Mailing Address - Phone:787-642-1977
Mailing Address - Fax:797-845-1840
Practice Address - Street 1:ST RUIZ BELVIS #3
Practice Address - Street 2:
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757
Practice Address - Country:US
Practice Address - Phone:787-642-1977
Practice Address - Fax:797-845-1840
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12548208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR300034OtherMMM
PR2365OtherPMC
H42995Medicare UPIN
PR300034OtherMMM