Provider Demographics
NPI:1669411211
Name:RIVERA, EDWIN ARIEL (MD)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:ARIEL
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:J19 CALLE ISLA VERDE
Mailing Address - Street 2:URB. EDUARDO J. SALDANA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983-1824
Mailing Address - Country:US
Mailing Address - Phone:787-640-7671
Mailing Address - Fax:
Practice Address - Street 1:J19 CALLE ISLA VERDE
Practice Address - Street 2:URB. EDUARDO J. SALDANA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983-1824
Practice Address - Country:US
Practice Address - Phone:787-640-7671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13980208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH84388Medicare UPIN
PR2-1496Medicare ID - Type UnspecifiedPROVIDER NUMBER