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General NPI Number Information
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NPI Number | 1194142521
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Entity Type | Organization
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Legal Business Name | DRA. JUDIBELLE RIVERA DE JESUS MD, PSC
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Dates
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Enumeration Date | 03/24/2014
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Last Update Date | 11/24/2014
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Provider Practice Location Address
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Address Line | 33 CALLE BALDORIOTY
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City | COAMO
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State | PR
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Zip | 00769-3122
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Country | US
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Telephone | 787-825-2420
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Fax |
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Provider Business Mailing Address
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Address Line | 41 CALLE TIBES MANSIONES DEL SUR
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City | COTO LAUREL
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State | PR
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Zip | 00780-2092
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Country | US
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Telephone | 787-825-2420
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Fax | 787-825-2565
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JUDIBELLE RIVERA
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Credential |
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Telephone | 787-825-2420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 12140
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License Number State | PR
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