Healthcare Provider Details

I. General information

NPI: 1588800379
Provider Name (Legal Business Name): JOSE DANIEL RIVERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2008
Last Update Date: 12/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 N GEORGE MASON DR SUITE 480
ARLINGTON VA
22205-3601
US

IV. Provider business mailing address

4710 GRAND BEND DR
CATONSVILLE MD
21228-3683
US

V. Phone/Fax

Practice location:
  • Phone: 703-522-7444
  • Fax:
Mailing address:
  • Phone: 410-247-6773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101050936
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: