Provider Demographics
NPI:1215907878
Name:RIVERA BOLOMEY, CEDRIC (MD)
Entity type:Individual
Prefix:DR
First Name:CEDRIC
Middle Name:
Last Name:RIVERA BOLOMEY
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 1:29 CALLE WASHINGTON STE 708
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1503
Mailing Address - Country:US
Mailing Address - Phone:787-724-3900
Mailing Address - Fax:787-723-6674
Practice Address - Street 1:29 CALLE WASHINGTON STE 708
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1503
Practice Address - Country:US
Practice Address - Phone:787-724-3900
Practice Address - Fax:787-723-6674
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8684174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR067323OtherCRUZ AZUL BLUE CROSS BS
PR9090065OtherHUMANA INSURANCE
PR0080982Medicare ID - Type UnspecifiedMEDICARE-TRIPLE S