Healthcare Provider Details

I. General information

NPI: 1225071699
Provider Name (Legal Business Name): JORGE RAFAEL BERRIOS-RIVERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE CASIA #10 VA CARIBBEAN HEALTH CARE SYSTEM VETERANS HOSPITAL
SAN JUAN PR
00921-3201
US

IV. Provider business mailing address

100 COND BOSQUE SERENO APT.158
BAYAMON PR
00957-4423
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-7582
  • Fax: 787-641-1621
Mailing address:
  • Phone: 787-366-0203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number9243
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: