MEDICARE: JHOMARIE RIVERA-PEREZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	16443	PR

General Provider Information

NPI Number	:	1265526271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JHOMARIE RIVERA-PEREZ MD

Provider Business Mailing Address
First Line	:	PO BOX 8202
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00732-8202
Country	:	US
Telephone Number	:	787-840-1110
Fax Number	:	787-840-0003

Provider Business Practice Location Address
First Line	:	2162 AVE LAS AMERICAS
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00717-0722
Country	:	US
Telephone Number	:	787-840-1110
Fax Number	:	787-840-0003

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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