Provider Demographics
NPI:1184911380
Name:JOSE, RIZA MINA (MD)
Entity type:Individual
Prefix:DR
First Name:RIZA
Middle Name:MINA
Last Name:JOSE
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 1:341 HOSPITAL AVE APT B
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1487
Mailing Address - Country:US
Mailing Address - Phone:845-282-6921
Mailing Address - Fax:
Practice Address - Street 1:100 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1440
Practice Address - Country:US
Practice Address - Phone:814-375-6440
Practice Address - Fax:814-375-3081
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD459442207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA002726772OtherHIGHMARK BCBS
PA1032104340001Medicaid
PA541285T20Medicare PIN