Provider Demographics
NPI:1851300727
Name:RIVERA VELAZQUEZ, JOSE MIGUEL
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:MIGUEL
Last Name:RIVERA VELAZQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 CAMINO YAGRUMO
Mailing Address - Street 2:URB. SABANERA
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739
Mailing Address - Country:US
Mailing Address - Phone:787-434-4560
Mailing Address - Fax:
Practice Address - Street 1:PLAZA LA SIERRA LOCAL #4 CARR. 172 KM. 20.3
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727
Practice Address - Country:US
Practice Address - Phone:787-685-6503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13372174400000X, 146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No174400000XOther Service ProvidersSpecialist