Provider Demographics
NPI:1417956954
Name:RIVERA, JOSE A (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 10189
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-0189
Mailing Address - Country:US
Mailing Address - Phone:787-856-2157
Mailing Address - Fax:787-856-2157
Practice Address - Street 1:32 CALLE MATTEI LLUBERAS
Practice Address - Street 2:
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-3635
Practice Address - Country:US
Practice Address - Phone:787-856-2157
Practice Address - Fax:787-856-2157
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2013-10-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR119212085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG06610Medicare UPIN