MEDICARE: DR. JOSE V RIVERA IRIZARRY M.D.

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	208D00000X	General Practice Physician	10981	PR

General Provider Information

NPI Number	:	1245238856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE V RIVERA IRIZARRY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1837
Second Line	:
City	:	GUAYAMA
State	:	PR
Zip	:	00785-1837
Country	:	US
Telephone Number	:	787-316-6746
Fax Number	:	787-866-4223

Provider Business Practice Location Address
First Line	:	83 CALLE ESTEBAN B CRUZ STE 3
Second Line	:	URB VIVES
City	:	GUAYAMA
State	:	PR
Zip	:	00784
Country	:	US
Telephone Number	:	787-839-6775
Fax Number	:	787-592-0631

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

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	10/25/2022

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