Provider Demographics
NPI:1891103164
Name:FERDINAND RIVERA VILLALBA C.S.P.
Entity Type:Organization
Organization Name:FERDINAND RIVERA VILLALBA C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FERDINAND
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA-VILLALBA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:787-833-6076
Mailing Address - Street 1:101 MENDEZ VIGO W
Mailing Address - Street 2:OF. 104
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-3847
Mailing Address - Country:US
Mailing Address - Phone:787-833-6076
Mailing Address - Fax:
Practice Address - Street 1:101 MENDEZ VIGO W
Practice Address - Street 2:OF. 104
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-3847
Practice Address - Country:US
Practice Address - Phone:787-833-6076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR27261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRT26838Medicare UPIN