Provider Demographics
NPI:1851379606
Name:RIVERA IRIZARRY, JOSE E (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:E
Last Name:RIVERA IRIZARRY
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:N7 CALLE 18
Mailing Address - Street 2:URB OASIS GARDENS
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-3411
Mailing Address - Country:US
Mailing Address - Phone:787-614-0979
Mailing Address - Fax:787-767-3852
Practice Address - Street 1:100 CALLE MORSE
Practice Address - Street 2:
Practice Address - City:ARROYO
Practice Address - State:PR
Practice Address - Zip Code:00714-2607
Practice Address - Country:US
Practice Address - Phone:787-271-1711
Practice Address - Fax:787-839-1117
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12297207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH55319Medicare UPIN
PR0089753Medicare ID - Type UnspecifiedPROVIDER