Provider Demographics
NPI:1821191115
Name:RIVERA-PEREZ, NESTOR (MD)
Entity Type:Individual
Prefix:DR
First Name:NESTOR
Middle Name:
Last Name:RIVERA-PEREZ
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:SABANA GARDENS 4 #5 CALLE 8
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983
Mailing Address - Country:US
Mailing Address - Phone:787-769-9675
Mailing Address - Fax:787-524-3163
Practice Address - Street 1:SABANA GARDENS 4 #5 CALLE 8
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983
Practice Address - Country:US
Practice Address - Phone:787-769-9675
Practice Address - Fax:787-524-3163
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4234207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR00025270OtherTRIPLE S
PRC 77305Medicare UPIN