Healthcare Provider Details

I. General information

NPI: 1255307070
Provider Name (Legal Business Name): JOSE G RIVERA GUILBE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 04/17/2022
Certification Date: 04/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 CALLE FLORENCIO SANTIAGO
COAMO PR
00769-3260
US

IV. Provider business mailing address

PO BOX 440 #30 FLORENCIO SANTIAGO
COAMO PR
00769-0440
US

V. Phone/Fax

Practice location:
  • Phone: 787-803-4659
  • Fax: 787-825-2296
Mailing address:
  • Phone: 787-825-2296
  • Fax: 939-732-7072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number11465
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: