Provider Demographics
NPI:1386651883
Name:RIVERA NEGRON, JOSE A (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:RIVERA NEGRON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CALLE RODRIGUEZ SERRA APT 1002
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1451
Mailing Address - Country:US
Mailing Address - Phone:787-637-1625
Mailing Address - Fax:
Practice Address - Street 1:1 CALLE RODRIGUEZ SERRA APT 1002
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1451
Practice Address - Country:US
Practice Address - Phone:787-637-1625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR408152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1386651883Medicaid