Provider Demographics
NPI:1457449902
Name:RIVERA VARGAS, JORGE D (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:D
Last Name:RIVERA VARGAS
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:PO BOX 2077
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-2077
Mailing Address - Country:US
Mailing Address - Phone:787-781-1636
Mailing Address - Fax:787-781-1636
Practice Address - Street 1:CARR 21 # 3T 4B
Practice Address - Street 2:URB LAS LOMAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-781-1636
Practice Address - Fax:787-781-1636
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR008084207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE66292Medicare UPIN
PR29798Medicare ID - Type Unspecified