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General NPI Number Information
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NPI Number | 1720489446
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Entity Type | Individual
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Provider Name | JORGE L RIVERA MIRABAL M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/12/2014
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | SAN JORGE MEDICAL OFFICE BUILDING SUITE 401 252 SAN JORGE STREET
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City | SAN JUAN
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State | PR
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Zip | 00912-0000
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Country | US
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Telephone | 787-726-1484
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Fax |
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Provider Business Mailing Address
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Address Line | SAN JORGE MEDICAL OFFICE BUILDING SUITE 401 252 SAN JORGE STREET
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City | SAN JUAN
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State | PR
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Zip | 00912-0000
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Country | US
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Telephone | 787-726-1484
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 024645
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 024645
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License Number State | PR
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Taxonomy #3
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | ME153764
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | BP10056345
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | BP10056345
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License Number State | TX
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