Healthcare Provider Details

I. General information

NPI: 1699761817
Provider Name (Legal Business Name): JOSE R. RIVERA-TOLEDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 12/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROAD 135 KM. 64.2 BOX 1003
CASTANER PR
00631-1003
US

IV. Provider business mailing address

ROAD 135 KM. 64.2 BOX 1003
CASTANER PR
00631-1003
US

V. Phone/Fax

Practice location:
  • Phone: 787-210-6411
  • Fax: 787-829-2913
Mailing address:
  • Phone: 787-210-6411
  • Fax: 787-829-2913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12508
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: