1912070384 NPI number — WILFREDO R RIVERA ESQUERDO DPM

Table of content: WILFREDO R RIVERA ESQUERDO DPM (NPI 1912070384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912070384 NPI number — WILFREDO R RIVERA ESQUERDO DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVERA ESQUERDO
Provider First Name:
WILFREDO
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1912070384
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:
PO BOX 70005
Provider Second Line Business Mailing Address:
PMB 293
Provider Business Mailing Address City Name:
FAJARDO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-655-4023
Provider Business Mailing Address Fax Number:
787-655-4024

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
TORRE SAN PABLO DEL ESTE SUITE 204
Provider Second Line Business Practice Location Address:
HOSPITAL HIMA SAN PABLO DEL ESTE
Provider Business Practice Location Address City Name:
FAJARDO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-655-4023
Provider Business Practice Location Address Fax Number:
787-655-4024
Provider Enumeration Date:
11/15/2006

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: 213E00000X , with the licence number:  31 , 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)





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