Provider Demographics
NPI:1922092758
Name:RIVERA IRIZARRY, JOMARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOMARIE
Middle Name:
Last Name:RIVERA IRIZARRY
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 1:148 CAMINO DEL VALLE
Mailing Address - Street 2:
Mailing Address - City:LUQUILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00773-2543
Mailing Address - Country:US
Mailing Address - Phone:787-719-4036
Mailing Address - Fax:787-719-4037
Practice Address - Street 1:109 CALLE FERNANDEZ GARCIA
Practice Address - Street 2:LOCAL B
Practice Address - City:LUQUILLO
Practice Address - State:PR
Practice Address - Zip Code:00773-2323
Practice Address - Country:US
Practice Address - Phone:787-719-4036
Practice Address - Fax:787-719-4037
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14978208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR14978OtherPR LICENSE
FLACN 568OtherFLORIDA LICENSE
FLACN 568OtherFLORIDA LICENSE
PR22805OtherTRIPLE SSS
PRI19156Medicare UPIN
FLACN 568OtherFLORIDA LICENSE