Healthcare Provider Details

I. General information

NPI: 1457398968
Provider Name (Legal Business Name): JOSE JULIAN RIVERA RODRIGUEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 PONCE DE LEON AVE SUITE 511 TORRE AUXILIO MUTUO
SAN JUAN PR
00917-5022
US

IV. Provider business mailing address

PO BOX 19122
SAN JUAN PR
00910-1122
US

V. Phone/Fax

Practice location:
  • Phone: 787-751-0842
  • Fax:
Mailing address:
  • Phone: 787-782-5854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number9411
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: