Healthcare Provider Details

I. General information

NPI: 1255396826
Provider Name (Legal Business Name): JOSE CRUZ RIVERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 04/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

O6 CALLE 6 URB ALTA VISTA
PONCE PR
00716
US

IV. Provider business mailing address

O6 CALLE 16 URB ALTA VISTA
PONCE PR
00716
US

V. Phone/Fax

Practice location:
  • Phone: 787-803-7017
  • Fax:
Mailing address:
  • Phone: 787-643-6658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12945
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: