Provider Demographics
NPI:1790124972
Name:HERNANDEZ RIVERA, JOSE FRANCISCO (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:FRANCISCO
Last Name:HERNANDEZ RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1600 SW ARCHER RD BOX 100296
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0001
Mailing Address - Country:US
Mailing Address - Phone:352-265-0462
Mailing Address - Fax:352-265-0443
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-1248
Practice Address - Country:US
Practice Address - Phone:352-265-0462
Practice Address - Fax:352-265-0443
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME117700208000000X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018049800Medicaid