Provider Demographics
NPI:1255798443
Name:RIVERA RIVERA, JASER
Entity type:Individual
Prefix:
First Name:JASER
Middle Name:
Last Name:RIVERA RIVERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARRETERA 1 KM 121.5
Mailing Address - Street 2:AEROPUERTO MERCEDITA BOX CALZEDA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00731
Mailing Address - Country:US
Mailing Address - Phone:787-929-6277
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 1 KM 121.5
Practice Address - Street 2:BOX CALZEDA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731
Practice Address - Country:US
Practice Address - Phone:787-848-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR70672111NR0400X, 163WG0000X, 282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRSP0003729OtherTRIPLE S