MEDICARE: RIVERA MIRABAL UROLOGY LLC

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	208600000X	Surgery Physician
2	208800000X	Urology Physician

General Provider Information

NPI Number	:	1396610325
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERA MIRABAL UROLOGY LLC

Provider Business Mailing Address
First Line	:	SAN JORGE MEDICAL OFFICE BUILDING SUITE 401
Second Line	:	SAN JORGE STREET 252
City	:	SAN JUAN
State	:	PR
Zip	:	00912-0000
Country	:	US
Telephone Number	:	787-726-1484
Fax Number	:

Provider Business Practice Location Address
First Line	:	SAN JORGE MEDICAL OFFICE BUILDING SUITE 401
Second Line	:	SAN JORGE STREET 252
City	:	SAN JUAN
State	:	PR
Zip	:	00912-0000
Country	:	US
Telephone Number	:	787-726-1484
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JORGE L RIVERA MIRABAL
Credential	:	M.D.
Telephone Number	:	787-726-1484

Provider Enumeration Date	:	10/08/2025
Last Update Date	:	10/08/2025

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