Provider Demographics
NPI:1831171636
Name:RIVERA COTTO, ANGEL RAUL SR (MD)
Entity type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:RAUL
Last Name:RIVERA COTTO
Suffix:SR
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 1582
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705
Mailing Address - Country:US
Mailing Address - Phone:787-735-8595
Mailing Address - Fax:787-735-4887
Practice Address - Street 1:AVE. MAIN BLOQUE 51 #39 SANTA ROSA
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-798-5615
Practice Address - Fax:787-786-9046
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6462207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
9-7814Medicare ID - Type Unspecified
PRD83356Medicare UPIN
D83356Medicare UPIN