Provider Demographics
NPI:1699084723
Name:RIVERA RIVERA, ENRIQUE J (MD)
Entity type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:J
Last Name:RIVERA 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:PO BOX 1176
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-1176
Mailing Address - Country:US
Mailing Address - Phone:787-269-4646
Mailing Address - Fax:
Practice Address - Street 1:100 PASEO SAN PABLO STE 502
Practice Address - Street 2:EDIFICIO DR. ARTURO CADILLA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7028
Practice Address - Country:US
Practice Address - Phone:787-269-4646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA41875207W00000X
TXBP10054386207W00000X
PR19345207W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRIS729AMedicare UPIN