Provider Demographics
NPI:1700875861
Name:RIVERA RIVERA, NELSON (MD)
Entity Type:Individual
Prefix:DR
First Name:NELSON
Middle Name:
Last Name:RIVERA 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 1:1 CALLE FIGUEROA
Mailing Address - Street 2:
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766-2226
Mailing Address - Country:US
Mailing Address - Phone:178-784-7777
Mailing Address - Fax:178-784-7777
Practice Address - Street 1:1 CALLE FIGUEROA
Practice Address - Street 2:
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766-2226
Practice Address - Country:US
Practice Address - Phone:178-784-7777
Practice Address - Fax:178-784-7777
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8828207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
28828OtherMCS
PR200110OtherMMM
061249OtherCRUZ AZUL
88860RIOtherSSS
PR0432OtherIMC
7660024OtherHUMANA
PR0432OtherIMC
PRG42416Medicare UPIN