Provider Demographics
NPI:1942406343
Name:RIVERA RODRIGUEZ, JOSE E (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:E
Last Name:RIVERA RODRIGUEZ
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:PO BOX 418
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-0418
Mailing Address - Country:US
Mailing Address - Phone:784-891-6565
Mailing Address - Fax:787-891-6566
Practice Address - Street 1:302 PROGRESO
Practice Address - Street 2:AGUADILLA XRAY OFFICE & BODY IMAGING CENTER # 2 Y #3
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00605-0418
Practice Address - Country:US
Practice Address - Phone:787-891-6565
Practice Address - Fax:787-891-6566
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0085892085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0090001Medicare ID - Type Unspecified
G91287Medicare UPIN