Healthcare Provider Details

I. General information

NPI: 1295761112
Provider Name (Legal Business Name): JOSE ANTONIO RIVERA-ZAMOT D.O., O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE 2 #37B PUERTO REAL
CABO ROJO PR
00623
US

IV. Provider business mailing address

236 RIVERA STREET LAS TORRES NORTE SUITE 3-D
BAYAMON PR
00960
US

V. Phone/Fax

Practice location:
  • Phone: 787-560-4868
  • Fax:
Mailing address:
  • Phone: 787-560-4868
  • Fax: 787-254-1939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number236
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: