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General NPI Number Information
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NPI Number | 1861573677
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Entity Type | Individual
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Provider Name | JOSE ANTONIO RIVERA VALLES M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 02/01/2023
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Provider Practice Location Address
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Address Line | AVE AMERICO MIRANDA ESQ CENTRO MEDICO
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City | SAN JUAN
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State | PR
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Zip | 00935-0001
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Country | US
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Telephone | 787-420-6331
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Fax | 939-336-9598
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Provider Business Mailing Address
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Address Line | PO BOX 194535
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City | SAN JUAN
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State | PR
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Zip | 00919-4535
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Country | US
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Telephone | 787-420-6331
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Fax | 787-799-6308
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 14709
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License Number State | PR
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