Provider Demographics
NPI:1235126707
Name:RIVERA-ZAYAS, JOSE LUIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:LUIS
Last Name:RIVERA-ZAYAS
Suffix:
Gender:M
Credentials:DMD
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 361477
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-1477
Mailing Address - Country:US
Mailing Address - Phone:787-773-0123
Mailing Address - Fax:787-773-0125
Practice Address - Street 1:576 CALLE CESAR GONZALEZ
Practice Address - Street 2:SUITE 301, DORAL BANK CENTER
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3756
Practice Address - Country:US
Practice Address - Phone:787-773-0123
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-30
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21071223P0700X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1166OtherFIRST MEDICAL DENTAL
PR41787OtherCRUZ AZUL DENTAL PLAN
PR42122RIOtherTRIPLE-S DENTAL PLAN
PR9690002OtherHUMANA HEALTH PLAN PR
PR9690002OtherHUMANA HEALTH REFORM
PR206198OtherUTI DENTAL