MEDICARE: DR. JOSE SANDALIO RIVERA IRIZARRY M.D.

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	208D00000X	General Practice Physician	ACN1364	FL
2	208D00000X	General Practice Physician	11901	PR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	400330	OTHER	PR	MEDICARE Y MUCHO MAS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	JSRI-819	OTHER	PR	MENONITA
2	N-752	OTHER	PR	INTERNATINAL MEDICAL CARD
4	87929	OTHER	PR	TRIPLE - S
5	0010804	OTHER	PR	HUMANA HEALTH PLANS (PR)
6	03286	OTHER	PR	AMERICAN HEALTH, INC.
7	1-2073-1	OTHER	PR	ACAA
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497742316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE SANDALIO RIVERA IRIZARRY M.D.

Provider Business Mailing Address
First Line	:	8333 NW 53RD ST FL 6
Second Line	:
City	:	DORAL
State	:	FL
Zip	:	33166-4783
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1990 N FEDERAL HWY
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-1032
Country	:	US
Telephone Number	:	954-942-2247
Fax Number	:	954-942-2265

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

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	06/03/2026

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