Provider Demographics
NPI:1447211677
Name:RIVERA-HERRERA, JORGE LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:LUIS
Last Name:RIVERA-HERRERA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:SAN JORGE MEDICAL OFFICE BUILDING . 401
Mailing Address - Street 2:SAN JORGE AVE. 252
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00912
Mailing Address - Country:US
Mailing Address - Phone:787-726-1484
Mailing Address - Fax:787-268-0972
Practice Address - Street 1:COND SAN JORGE # 252
Practice Address - Street 2:SAN JORGE MEDICAL OFFICE BUILDING SUITE 401
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00912-3359
Practice Address - Country:US
Practice Address - Phone:787-726-1484
Practice Address - Fax:787-268-0972
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2008-04-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR11152208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0083350Medicare PIN
PRF58747Medicare UPIN