Provider Demographics
NPI:1356314652
Name:RIVERA ESPARRA, JOSE J (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:J
Last Name:RIVERA ESPARRA
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 1:5005 CONSTANCIA
Mailing Address - Street 2:URB HACIENDAS DEL MONTE
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-0000
Mailing Address - Country:US
Mailing Address - Phone:787-207-4297
Mailing Address - Fax:787-842-3512
Practice Address - Street 1:623 AVE LA CEIBA
Practice Address - Street 2:ROVIRA OFFICE PARK SUITE 103
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0000
Practice Address - Country:US
Practice Address - Phone:787-973-0010
Practice Address - Fax:787-973-0011
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR14200OtherLICENCIA
PR14200OtherLICENCIA