Healthcare Provider Details

I. General information

NPI: 1336537695
Provider Name (Legal Business Name): JOSE LUIS RIOS RUSSO MD, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2015
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. CONDADO MODERNO M-13
CAGUAS PR
00725
US

IV. Provider business mailing address

URB. CONDADO MODERNO M-13
CAGUAS PR
00725
US

V. Phone/Fax

Practice location:
  • Phone: 787-745-4355
  • Fax: 787-745-4399
Mailing address:
  • Phone: 787-745-4355
  • Fax: 787-745-4399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number22392
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number22392
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number22392
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: