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General NPI Number Information
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NPI Number | 1841386786
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Entity Type | Individual
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Provider Name | JUDIBELLE RIVERA DE JESUS MD
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Gender | Female
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 10/29/2012
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Provider Practice Location Address
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Address Line | 33 CALLE BALDONOTY
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City | COAMO
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State | PR
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Zip | 00769
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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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Provider Business Mailing Address
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Address Line | 41 CALLE TIBES MANSIONES DEL SUR
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City | COTTO 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 |
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 12140
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License Number State | PR
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