MEDICARE: DR. JORGE LUIS RIVERA-HERRERA 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	208800000X	Urology Physician	11152	PR

General Provider Information

NPI Number	:	1447211677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORGE LUIS RIVERA-HERRERA MD

Provider Business Mailing Address
First Line	:	SAN JORGE MEDICAL OFFICE BUILDING . 401
Second Line	:	SAN JORGE AVE. 252
City	:	SAN JUAN
State	:	PR
Zip	:	00912
Country	:	US
Telephone Number	:	787-726-1484
Fax Number	:	787-268-0972

Provider Business Practice Location Address
First Line	:	COND SAN JORGE # 252
Second Line	:	SAN JORGE MEDICAL OFFICE BUILDING SUITE 401
City	:	SANTURCE
State	:	PR
Zip	:	00912-3359
Country	:	US
Telephone Number	:	787-726-1484
Fax Number	:	787-268-0972

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

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	04/10/2008

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