Provider Demographics
NPI:1760922728
Name:RIVERA RIOS, JEANEISHKA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:JEANEISHKA
Middle Name:MARIE
Last Name:RIVERA RIOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 CALLE DIAMANTE
Mailing Address - Street 2:URBANIZACIOB QUINTAS DE TORTUGUERO
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:787-925-7008
Mailing Address - Fax:
Practice Address - Street 1:BARRIO MONACILLOS RIO PIEDRAS
Practice Address - Street 2:CENTRO MEDICO DE PR
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925
Practice Address - Country:US
Practice Address - Phone:787-925-7008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-24
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR34891390200000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program