1245283431 NPI number — MR. ELVIN GERARDO RIVERA MD

Table of content: NNAMDI UBOZOH RN (NPI 1386208593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245283431 NPI number — MR. ELVIN GERARDO RIVERA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVERA
Provider First Name:
ELVIN
Provider Middle Name:
GERARDO
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245283431
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ASHFORD AVE #1477
Provider Second Line Business Mailing Address:
APT 501
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-728-4474
Provider Business Mailing Address Fax Number:
787-725-2964

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29 WASHINGTON ST
Provider Second Line Business Practice Location Address:
ASHFORD MEDICAL CENTER STE 709
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-725-2964
Provider Business Practice Location Address Fax Number:
787-725-2964
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  12037 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 600509 . This is a "MMM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10312037CA . This is a "GLOBAL HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 220271 . This is a "PREFERRED HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 060280 . This is a "CA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2490 . This is a "AMERICAN HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: SE4306 . This is a "PALIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9021 . This is a "IMC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9120264 . This is a "HUMANA HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 88600RI . This is a "SSS" identifier . This identifiers is of the category "OTHER".




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