Provider Demographics
NPI:1225144868
Name:RIVERA, JOSE DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:DAVID
Last Name: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:PO BOX 141929
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-1929
Mailing Address - Country:US
Mailing Address - Phone:787-880-2200
Mailing Address - Fax:787-878-0532
Practice Address - Street 1:19 AVE JOSE DE DIEGO
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4546
Practice Address - Country:US
Practice Address - Phone:787-880-2200
Practice Address - Fax:787-878-0532
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8871207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE10145Medicare UPIN
PR0081504Medicare ID - Type UnspecifiedMEDICARE NUMBER