Provider Demographics
NPI:1265582068
Name:RIVERA-RODRIGUEZ, JOSE ALBERTO (MEDICINE DOCTOR)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ALBERTO
Last Name:RIVERA-RODRIGUEZ
Suffix:
Gender:M
Credentials:MEDICINE DOCTOR
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:A
Other - Last Name:RIVERA-RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MEDICINE DOCTOR
Mailing Address - Street 1:361 SARGENTO LUIS MEDINA ST.
Mailing Address - Street 2:NUMBER 1
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3817
Mailing Address - Country:US
Mailing Address - Phone:787-763-8216
Mailing Address - Fax:787-294-1083
Practice Address - Street 1:361 SARGENTO LUIS MEDINA
Practice Address - Street 2:URB.ROOSEVELT
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3817
Practice Address - Country:US
Practice Address - Phone:787-763-8216
Practice Address - Fax:787-294-1083
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4671207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE-31174Medicare ID - Type UnspecifiedGASTROENTEROLOGY OUTPATIE