Provider Demographics
NPI:1306736681
Name:RIVERA, JEAN CARLO SR (MD)
Entity type:Individual
Prefix:
First Name:JEAN CARLO
Middle Name:
Last Name:RIVERA
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JEAN CARLO
Other - Middle Name:
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:VILLAS DEL PILAR CALLE # 2 D 1
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-216-7555
Mailing Address - Fax:
Practice Address - Street 1:VILLAS DEL PILAR CALLE # 2 D 1
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-216-7555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6619957207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine