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General NPI Number Information
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NPI Number | 1649881434
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Entity Type | Organization
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Legal Business Name | DR JOSE A RIVERA LLC
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Dates
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Enumeration Date | 08/14/2020
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 822 A1A N STE 310
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City | PONTE VEDRA BEACH
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State | FL
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Zip | 32082-8209
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Country | US
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Telephone | 251-901-3011
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8209
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City | VIENNA
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State | VA
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Zip | 22183-2058
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Country | US
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Telephone | 251-901-3011
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Fax | 833-469-6349
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSE ARNALDO RIVERA
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Credential | DPM
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Telephone | 251-901-3011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number |
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License Number State |
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