Provider Demographics
NPI:1700976495
Name:RIVERA PAZ, HUMBERTO (MD)
Entity Type:Individual
Prefix:MR
First Name:HUMBERTO
Middle Name:
Last Name:RIVERA PAZ
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 1:128 CALLE COMPRENSION PARAISO DE MAYAGUEZ
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-223-9062
Mailing Address - Fax:
Practice Address - Street 1:CARR. 115 KM. 24.5
Practice Address - Street 2:BARRIO ASOMANTE
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-0060
Practice Address - Country:US
Practice Address - Phone:787-589-7400
Practice Address - Fax:787-589-7402
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2021-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15013208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1-43980Medicare UPIN
PR2-3617Medicare ID - Type Unspecified