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General NPI Number Information
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NPI Number | 1790083301
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Entity Type | Organization
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Legal Business Name | JOSE L RIVERA ZAYAS DENTAL PSC
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Dates
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Enumeration Date | 03/06/2011
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Last Update Date | 03/06/2011
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Provider Practice Location Address
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Address Line | 576 CALLE CESAR GONZALEZ SUITE 301
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City | SAN JUAN
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State | PR
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Zip | 00918-3756
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Country | US
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Telephone | 787-773-0123
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 364881
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City | SAN JUAN
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State | PR
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Zip | 00936-4881
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Country | US
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Telephone | 787-773-0123
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSE LUIS RIVERA ZAYAS
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Credential | DMD
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Telephone | 787-773-0123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 2107
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License Number State | PR
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