Provider Demographics
NPI:1245238856
Name:RIVERA IRIZARRY, JOSE V (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:V
Last Name:RIVERA IRIZARRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1837
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-1837
Mailing Address - Country:US
Mailing Address - Phone:787-316-6746
Mailing Address - Fax:787-866-4223
Practice Address - Street 1:83 CALLE ESTEBAN B CRUZ STE 3
Practice Address - Street 2:URB VIVES
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-839-6775
Practice Address - Fax:787-592-0631
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR10981208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG41083Medicare UPIN