Provider Demographics
NPI:1851927610
Name:RIVERA, PEDRO JOSE (PA)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:JOSE
Last Name:RIVERA
Suffix:
Gender:M
Credentials:PA
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 953
Mailing Address - Street 2:
Mailing Address - City:PENUELAS
Mailing Address - State:PR
Mailing Address - Zip Code:00624-0953
Mailing Address - Country:US
Mailing Address - Phone:787-238-0757
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 132 KM 9.2 INTERIOR BARRIO COTTO QUEBRADAS SE
Practice Address - Street 2:
Practice Address - City:PENUELAS
Practice Address - State:PR
Practice Address - Zip Code:00624
Practice Address - Country:US
Practice Address - Phone:787-238-0757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-12
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR724-PA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant