1457310633 NPI number — DR. OMAR RIVERA D.M.D

Table of content: DR. OMAR RIVERA D.M.D (NPI 1457310633)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457310633 NPI number — DR. OMAR RIVERA D.M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVERA
Provider First Name:
OMAR
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.M.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RIVERA
Provider Other First Name:
OMAR
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.M.D
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1457310633
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HC-71 BOX 3278
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NARANJITO
Provider Business Mailing Address State Name:
PUERTO RICO
Provider Business Mailing Address Postal Code:
00719
Provider Business Mailing Address Country Code:
UY
Provider Business Mailing Address Telephone Number:
787-870-5225
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BO QUEBRADILLAS
Provider Second Line Business Practice Location Address:
CARR 152 KM 7.6
Provider Business Practice Location Address City Name:
BARRANQUITAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00794
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-370-4346
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/17/2006

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: 1223G0001X , with the licence number:  2524 , 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)