Provider Demographics
NPI:1790985471
Name:CARRERAS-RIVERA, JOSE A (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:CARRERAS-RIVERA
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 1773
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-1773
Mailing Address - Country:US
Mailing Address - Phone:787-948-2039
Mailing Address - Fax:
Practice Address - Street 1:30 CALLE PADIAL
Practice Address - Street 2:GATSBY PLAZA SUIT 318
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-3597
Practice Address - Country:US
Practice Address - Phone:787-948-2039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16834208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice