MEDICARE: JORGE RIVERA-DIAZ 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	207R00000X	Internal Medicine Physician	ME64485	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457479941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE RIVERA-DIAZ M.D.

Provider Business Mailing Address
First Line	:	15720 SW 45TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-3811
Country	:	US
Telephone Number	:	305-221-7457
Fax Number	:	305-480-8056

Provider Business Practice Location Address
First Line	:	681 EAST 9TH STREET
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010
Country	:	US
Telephone Number	:	305-805-8550
Fax Number	:	305-805-8549

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/08/2007

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