1104669506 NPI number — DR. WILLIAM JOEL RIVERA CARRERO MD

Table of content: DR. WILLIAM JOEL RIVERA CARRERO MD (NPI 1104669506)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104669506 NPI number — DR. WILLIAM JOEL RIVERA CARRERO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVERA CARRERO
Provider First Name:
WILLIAM
Provider Middle Name:
JOEL
Provider Name Prefix Text:
DR.
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:
1104669506
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8309 KELSALL DR # 32823
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32832-6322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-404-1292
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HOSPITAL BUEN SAMARITANO CARR. EST. PR-460, KM. 0.2
Provider Second Line Business Practice Location Address:
BO. CAIMITAL BAJO AGUADILLA PUERTO RICO, 00603
Provider Business Practice Location Address City Name:
AGUADILLA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-658-0000
Provider Business Practice Location Address Fax Number:
787-819-0805
Provider Enumeration Date:
06/14/2024

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com