MEDICARE: DR. JOSE LUIS RIESTRA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	5936	PR

General Provider Information

NPI Number	:	1184698797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE LUIS RIESTRA MD

Provider Business Mailing Address
First Line	:	Y2 CALLE HASTINGS
Second Line	:	GARDEN HILLS
City	:	GUAYNABO
State	:	PR
Zip	:	00966-2832
Country	:	US
Telephone Number	:	787-781-6889
Fax Number	:

Provider Business Practice Location Address
First Line	:	68 CALLE SANTA CRUZ
Second Line	:	TORRE SAN PABLO, SUITE 904
City	:	BAYAMON
State	:	PR
Zip	:	00961-7031
Country	:	US
Telephone Number	:	787-780-5369
Fax Number	:	787-780-5527

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	07/08/2007

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