Provider Demographics
NPI:1245647825
Name:RIVERA-NEVAREZ, JOSE A (M D)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:RIVERA-NEVAREZ
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:Q5 CALLE RENO
Mailing Address - Street 2:VISTA BELLA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-4824
Mailing Address - Country:US
Mailing Address - Phone:787-942-5238
Mailing Address - Fax:
Practice Address - Street 1:BO. MONA CILLOS 150 AVE AMERICO MIRANDA AREA CENTRO
Practice Address - Street 2:MEDICO MET
Practice Address - City:SANJUAN
Practice Address - State:PR
Practice Address - Zip Code:00935
Practice Address - Country:US
Practice Address - Phone:787-763-4149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13,466-I390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program