Provider Demographics
NPI:1649289398
Name:RIVERA, ANGEL L (MD)
Entity type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:L
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 1:16 CALLE VANDA
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-3151
Mailing Address - Country:US
Mailing Address - Phone:787-781-8506
Mailing Address - Fax:
Practice Address - Street 1:SUITE 205 HOSPITAL METROPOLITANO
Practice Address - Street 2:CARRETERA 21 #1785
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-781-8506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3346207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR24086Medicare ID - Type Unspecified
PRD08282Medicare UPIN