Provider Demographics
NPI:1972827715
Name:RIVERA, EUGENIO (MT)
Entity Type:Individual
Prefix:MR
First Name:EUGENIO
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CALLE BARCELO STE 217
Mailing Address - Street 2:
Mailing Address - City:BARRANQUITAS
Mailing Address - State:PR
Mailing Address - Zip Code:00794-1737
Mailing Address - Country:US
Mailing Address - Phone:787-857-7777
Mailing Address - Fax:787-857-3792
Practice Address - Street 1:3 CALLE BARCELO STE 217
Practice Address - Street 2:
Practice Address - City:BARRANQUITAS
Practice Address - State:PR
Practice Address - Zip Code:00794-1737
Practice Address - Country:US
Practice Address - Phone:787-857-7777
Practice Address - Fax:787-857-3792
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR806291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0038287Medicare PIN