Provider Demographics
NPI:1942406848
Name:RIVERA-DUENO, JAIME (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:
Last Name:RIVERA-DUENO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JAIME
Other - Middle Name:
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1229 CARR. 844
Mailing Address - Street 2:APT. 904
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-620-9235
Mailing Address - Fax:787-620-9409
Practice Address - Street 1:1299 CARR 844
Practice Address - Street 2:APT. 904
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-7835
Practice Address - Country:US
Practice Address - Phone:787-620-9235
Practice Address - Fax:787-620-9409
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2696208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics