Provider Demographics
NPI:1851334262
Name:RIVERA, DAVID
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-0489
Mailing Address - Country:US
Mailing Address - Phone:787-798-9522
Mailing Address - Fax:
Practice Address - Street 1:BAYAMON MEDICAL PLZ
Practice Address - Street 2:SUITE 104-A CARRETERA #2
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-7200
Practice Address - Country:US
Practice Address - Phone:787-798-9522
Practice Address - Fax:787-798-9500
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6089207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1851334262OtherNPI
PRC78187Medicare ID - Type Unspecified
PR1851334262OtherNPI