Provider Demographics
NPI:1215985304
Name:RIVERA REVERON, CESAR RAFAEL (MD)
Entity type:Individual
Prefix:DR
First Name:CESAR
Middle Name:RAFAEL
Last Name:RIVERA REVERON
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:O29 CALLE 19
Mailing Address - Street 2:FLAMBOYAN GARDEN
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-5729
Mailing Address - Country:US
Mailing Address - Phone:787-894-5041
Mailing Address - Fax:787-894-5041
Practice Address - Street 1:O29 CALLE 19
Practice Address - Street 2:FLAMBOYAN GARDEN
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-5729
Practice Address - Country:US
Practice Address - Phone:787-894-5041
Practice Address - Fax:787-894-5041
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2018-01-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR11850207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH04010Medicare UPIN