Provider Demographics
NPI:1871822700
Name:RIVERA, JOMARIE E (MD)
Entity Type:Individual
Prefix:
First Name:JOMARIE
Middle Name:E
Last Name:RIVERA
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 1:57 CALLE E
Mailing Address - Street 2:P MATTEI
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-9023
Mailing Address - Country:US
Mailing Address - Phone:787-691-0218
Mailing Address - Fax:
Practice Address - Street 1:57 CALLE E
Practice Address - Street 2:P MATTEI
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-691-0218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17799208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice