Provider Demographics
NPI:1225071699
Name:BERRIOS-RIVERA, JORGE RAFAEL (MD)
Entity Type:Individual
Prefix:MR
First Name:JORGE
Middle Name:RAFAEL
Last Name:BERRIOS-RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 COND BOSQUE SERENO
Mailing Address - Street 2:APT.158
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957-4423
Mailing Address - Country:US
Mailing Address - Phone:787-366-0203
Mailing Address - Fax:
Practice Address - Street 1:CALLE CASIA #10
Practice Address - Street 2:VA CARIBBEAN HEALTH CARE SYSTEM VETERANS HOSPITAL
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3201
Practice Address - Country:US
Practice Address - Phone:787-641-7582
Practice Address - Fax:787-641-1621
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9243225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR81563Medicare ID - Type Unspecified