Provider Demographics
NPI:1588139638
Name:RIVERA OSORIO, ANGEL JAVIER (BHE)
Entity type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:JAVIER
Last Name:RIVERA OSORIO
Suffix:
Gender:M
Credentials:BHE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:F48 CALLE 3
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-4212
Mailing Address - Country:US
Mailing Address - Phone:787-554-5504
Mailing Address - Fax:787-723-6247
Practice Address - Street 1:CDT DR. GUALBERTO RABELL C/ CERRA FINAL 900 PARADA 15
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-480-3833
Practice Address - Fax:787-723-6247
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5059-2174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator