Healthcare Provider Details

I. General information

NPI: 1912734310
Provider Name (Legal Business Name): OBED JOSUE RIVERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 09/18/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VILLA DE SANTON CRISOSTOMA CASTRO B4
CAROLINA PR
00987
US

IV. Provider business mailing address

VILLA DE SANTON CRISOSTOMA CASTRO B4
CAROLINA PR
00987
US

V. Phone/Fax

Practice location:
  • Phone: 787-462-5343
  • Fax:
Mailing address:
  • Phone: 787-462-5343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC3500X
TaxonomyCardiac Rehabilitation Registered Nurse
License Number91231
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: