Provider Demographics
NPI:1275557373
Name:ONEILL-RIVERA, JOSE G (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:G
Last Name:ONEILL-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 1:561 CALLE SUNLIGHT
Mailing Address - Street 2:SAN JUAN
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920-4311
Mailing Address - Country:US
Mailing Address - Phone:787-786-6115
Mailing Address - Fax:787-740-3088
Practice Address - Street 1:ARTURO CADILLA BUILDING SUITE 201
Practice Address - Street 2:BAYAMON
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-786-6115
Practice Address - Fax:787-740-3088
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR81802086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD32344Medicare UPIN
PR0029557Medicare ID - Type UnspecifiedMEDICARE