Healthcare Provider Details

I. General information

NPI: 1255798443
Provider Name (Legal Business Name): JASER RIVERA RIVERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2016
Last Update Date: 01/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 1 KM 121.5 BOX CALZEDA
PONCE PR
00731
US

IV. Provider business mailing address

CARRETERA 1 KM 121.5 AEROPUERTO MERCEDITA BOX CALZEDA
PONCE PR
00731
US

V. Phone/Fax

Practice location:
  • Phone: 787-848-2100
  • Fax:
Mailing address:
  • Phone: 787-929-6277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number70672
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number70672
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number70672
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: