MEDICARE: DR. JORGE L RIVERA MIRABAL 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	208800000X	Urology Physician	024645	PR
2	208600000X	Surgery Physician	024645	PR
3	208800000X	Urology Physician	ME153764	FL
4	208800000X	Urology Physician	BP10056345	TX
5	208600000X	Surgery Physician	BP10056345	TX

General Provider Information

NPI Number	:	1720489446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORGE L RIVERA MIRABAL M.D.

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

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

Provider Enumeration Date	:	09/12/2014
Last Update Date	:	10/10/2025

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Directions to “ DR. JORGE L RIVERA MIRABAL M.D.” Practice Location

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