Basic Information
| Provider Information | |||||||||
| NPI: | 1699062612 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIVERA | ||||||||
| FirstName: | WILHEM | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 3RD ST SW APT 106 | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200244405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178512345 | ||||||||
| FaxNumber: | 7178514513 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 INDIANA AVE NW STE 1230 | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200012131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028790220 | ||||||||
| FaxNumber: | 2028791618 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2011 | ||||||||
| LastUpdateDate: | 07/18/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MT200509 | PA | N | Allopathic & Osteopathic Physicians | Surgery | 2084P0800X | MD043185 | DC | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.