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General NPI Number Information
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NPI Number | 1093197683
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Entity Type | Organization
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Legal Business Name | J.R.A.GASTROENTEROLOGY
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Dates
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Enumeration Date | 06/19/2015
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Last Update Date | 06/19/2015
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Provider Practice Location Address
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Address Line | AVE. PONCE DE LEON #735 TORRE MEDICA AUXILIO MUTUO SUITE #816
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City | SAN JUAN
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State | PR
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Zip | 00917
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Country | US
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Telephone | 787-765-1025
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Fax |
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Provider Business Mailing Address
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Address Line | 138 AVE WINSTON CHURCHILL PMB 357
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City | SAN JUAN
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State | PR
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Zip | 00926-6013
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Country | US
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Telephone | 787-763-1020
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Fax | 787-250-1928
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSE E. RIVERA-ACOSTA
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Credential | M.D.
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Telephone | 787-598-1555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RT0003X
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Taxonomy Name | Transplant Hepatology Physician
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License Number | 17183
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 17183
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License Number State | PR
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