Healthcare Provider Details

I. General information

NPI: 1285626408
Provider Name (Legal Business Name): JORGE RIVERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 05/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 CALLE YAGUER
GUANICA PR
00653
US

IV. Provider business mailing address

PO BOX 1256
GUANICA PR
00653-1256
US

V. Phone/Fax

Practice location:
  • Phone: 787-821-5258
  • Fax: 787-821-3116
Mailing address:
  • Phone: 787-821-5258
  • Fax: 787-821-3116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11818
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: