Provider Demographics
NPI:1841386786
Name:RIVERA DE JESUS, JUDIBELLE (MD)
Entity Type:Individual
Prefix:
First Name:JUDIBELLE
Middle Name:
Last Name:RIVERA DE JESUS
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 1:41 CALLE TIBES
Mailing Address - Street 2:MANSIONES DEL SUR
Mailing Address - City:COTTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-2092
Mailing Address - Country:US
Mailing Address - Phone:787-825-2420
Mailing Address - Fax:787-825-2565
Practice Address - Street 1:33 CALLE BALDONOTY
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769
Practice Address - Country:US
Practice Address - Phone:787-825-2420
Practice Address - Fax:787-825-2565
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12140207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G44332Medicare UPIN
88806Medicare ID - Type Unspecified