Healthcare Provider Details

I. General information

NPI: 1497742316
Provider Name (Legal Business Name): JOSE SANDALIO RIVERA IRIZARRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 N FEDERAL HWY
POMPANO BEACH FL
33062-1032
US

IV. Provider business mailing address

8333 NW 53RD ST FL 6
DORAL FL
33166-4783
US

V. Phone/Fax

Practice location:
  • Phone: 954-942-2247
  • Fax: 954-942-2265
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1364
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number11901
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: