Healthcare Provider Details

I. General information

NPI: 1235126707
Provider Name (Legal Business Name): JOSE LUIS RIVERA-ZAYAS D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 CALLE CESAR GONZALEZ SUITE 301, DORAL BANK CENTER
SAN JUAN PR
00918-3756
US

IV. Provider business mailing address

PO BOX 361477
SAN JUAN PR
00936-1477
US

V. Phone/Fax

Practice location:
  • Phone: 787-773-0123
  • Fax:
Mailing address:
  • Phone: 787-773-0123
  • Fax: 787-773-0125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number2107
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2107
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: