Provider Demographics
NPI:1194824664
Name:RIVERA, AMILCAR (MD)
Entity type:Individual
Prefix:
First Name:AMILCAR
Middle Name:
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 1805
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-1805
Mailing Address - Country:US
Mailing Address - Phone:787-714-1999
Mailing Address - Fax:787-714-1999
Practice Address - Street 1:NUM. 80 CALLE 3 SUR
Practice Address - Street 2:
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784-1805
Practice Address - Country:US
Practice Address - Phone:787-866-1212
Practice Address - Fax:787-866-3322
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8593208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics