Provider Demographics
NPI:1497742316
Name:RIVERA IRIZARRY, JOSE SANDALIO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:SANDALIO
Last Name:RIVERA IRIZARRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:339 CYPRESS PKWY
Mailing Address - Street 2:STE 110
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759-3315
Mailing Address - Country:US
Mailing Address - Phone:407-343-5000
Mailing Address - Fax:407-343-5199
Practice Address - Street 1:211 CALLE MORSE
Practice Address - Street 2:
Practice Address - City:ARROYO
Practice Address - State:PR
Practice Address - Zip Code:00714-2350
Practice Address - Country:US
Practice Address - Phone:787-839-3980
Practice Address - Fax:787-271-2515
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR11901208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRJSRI-819OtherMENONITA
PRN-752OtherINTERNATINAL MEDICAL CARD
PR400330OtherMEDICARE Y MUCHO MAS
PR87929OtherTRIPLE - S
PR0010804OtherHUMANA HEALTH PLANS (PR)
PR03286OtherAMERICAN HEALTH, INC.
PR1-2073-1OtherACAA
PR03286OtherAMERICAN HEALTH, INC.
PR0010804OtherHUMANA HEALTH PLANS (PR)