Provider Demographics
NPI:1902009814
Name:RIVERA, CARLOS ROBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ROBERTO
Last Name:RIVERA
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 1:99 CALLE MIRADOR
Mailing Address - Street 2:PASEO ALTO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5919
Mailing Address - Country:US
Mailing Address - Phone:787-568-2428
Mailing Address - Fax:
Practice Address - Street 1:99 CALLE MIRADOR
Practice Address - Street 2:PASEO ALTO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-5919
Practice Address - Country:US
Practice Address - Phone:787-568-2428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7356174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist