Provider Demographics
NPI:1780712216
Name:RIVERA, PEDRO LUIS (MD)
Entity type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:LUIS
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:PO BOX 227
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-0227
Mailing Address - Country:US
Mailing Address - Phone:787-892-5265
Mailing Address - Fax:787-892-5265
Practice Address - Street 1:DR. VEVE STREET #59
Practice Address - Street 2:SECOND LEVEL
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-892-5265
Practice Address - Fax:787-892-5265
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR98102080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine