Provider Demographics
NPI:1073652814
Name:DR JORGE RIVERA TORRES PSC
Entity Type:Organization
Organization Name:DR JORGE RIVERA TORRES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-821-5258
Mailing Address - Street 1:PO BOX 1256
Mailing Address - Street 2:
Mailing Address - City:GUANICA
Mailing Address - State:PR
Mailing Address - Zip Code:00653-1256
Mailing Address - Country:US
Mailing Address - Phone:787-821-5258
Mailing Address - Fax:787-821-3116
Practice Address - Street 1:26 CALLE YAGUER
Practice Address - Street 2:
Practice Address - City:GUANICA
Practice Address - State:PR
Practice Address - Zip Code:00653-2530
Practice Address - Country:US
Practice Address - Phone:787-821-5258
Practice Address - Fax:787-821-3116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR011818207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR11818OtherLICENCE
PR0085443Medicare PIN
PRG41269Medicare UPIN