Provider Demographics
NPI:1649353152
Name:RIVERA, JAVIER A (MD)
Entity type:Individual
Prefix:DR
First Name:JAVIER
Middle Name:A
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JAVIER
Other - Middle Name:A
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:OROCOVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00720-1475
Mailing Address - Country:US
Mailing Address - Phone:787-867-0940
Mailing Address - Fax:787-867-0313
Practice Address - Street 1:AVE LUIS MUNOZ MARIN
Practice Address - Street 2:16
Practice Address - City:OROCOVIS
Practice Address - State:PR
Practice Address - Zip Code:00720
Practice Address - Country:US
Practice Address - Phone:787-867-0940
Practice Address - Fax:787-867-0313
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5983170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR27559Medicare ID - Type Unspecified
PRE66285Medicare UPIN