Healthcare Provider Details

I. General information

NPI: 1649111618
Provider Name (Legal Business Name): JAN MICHAEL RIVERA GUERRA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 HOLLAND AVE
ALBANY NY
12208-3469
US

IV. Provider business mailing address

FUENTEBELLA TORINO 1605
TOA ALTA PR
00953
US

V. Phone/Fax

Practice location:
  • Phone: 518-694-7868
  • Fax:
Mailing address:
  • Phone: 787-902-4417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: