Provider Demographics
NPI:1912070384
Name:RIVERA ESQUERDO, WILFREDO R (DPM)
Entity Type:Individual
Prefix:
First Name:WILFREDO
Middle Name:R
Last Name:RIVERA ESQUERDO
Suffix:
Gender:M
Credentials:DPM
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 70005
Mailing Address - Street 2:PMB 293
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738
Mailing Address - Country:US
Mailing Address - Phone:787-655-4023
Mailing Address - Fax:787-655-4024
Practice Address - Street 1:TORRE SAN PABLO DEL ESTE SUITE 204
Practice Address - Street 2:HOSPITAL HIMA SAN PABLO DEL ESTE
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-655-4023
Practice Address - Fax:787-655-4024
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR31213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0048022Medicare ID - Type Unspecified
T26840Medicare UPIN