Provider Demographics
NPI:1386616258
Name:RIVERA, MANUEL H (MD)
Entity type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:H
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:URB. PALACIOS DEL MONTE #1546 C/KILIMANJARO D-12
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:787-505-5749
Mailing Address - Fax:787-505-5749
Practice Address - Street 1:CARR #1 KM 26.9 BO. RIO CANAS SECT. LA CHANGA
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-505-5749
Practice Address - Fax:787-653-6700
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15792208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice