Healthcare Provider Details

I. General information

NPI: 1407969702
Provider Name (Legal Business Name): JOSE LUIS CANGIANO-RIVERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 05/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 AVE DOMENECH SUITE 101
SAN JUAN PR
00918-3531
US

IV. Provider business mailing address

PO BOX 11428
SAN JUAN PR
00910-2528
US

V. Phone/Fax

Practice location:
  • Phone: 787-763-7423
  • Fax: 787-763-2039
Mailing address:
  • Phone: 787-763-7423
  • Fax: 787-763-2039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number3416
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: