Provider Demographics
NPI:1396148094
Name:DR DOMENECH FIGUEROA RIVERA MD CSP
Entity type:Organization
Organization Name:DR DOMENECH FIGUEROA RIVERA MD CSP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMENECH
Authorized Official - Middle Name:A
Authorized Official - Last Name:FIGUEROA RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-816-1212
Mailing Address - Street 1:PO BOX 142601
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-2601
Mailing Address - Country:US
Mailing Address - Phone:787-816-1212
Mailing Address - Fax:787-881-6392
Practice Address - Street 1:CARR. # 2 KM. 67.3
Practice Address - Street 2:BO. SANTANA
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-0000
Practice Address - Country:US
Practice Address - Phone:787-816-1212
Practice Address - Fax:787-881-6392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-08
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14906208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR100925Medicare UPIN