Provider Demographics
NPI:1295758043
Name:RIVERA, JOSE ANGEL (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ANGEL
Last Name:RIVERA
Suffix:
Gender:M
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:PO BOX 8883
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-8883
Mailing Address - Country:US
Mailing Address - Phone:787-844-3569
Mailing Address - Fax:
Practice Address - Street 1:8122 CALLE CONCORDIA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00732-8883
Practice Address - Country:US
Practice Address - Phone:787-844-3569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12389207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR12612389OtherGLOBAL HEALTH
PR060683OtherCRUZ AZUL DE PR
PR209420OtherPREFERRED HEALTH
PR89564OtherTRIPLE SSS
PR2271OtherFIRST MEDICAL
PR1227OtherAMERICAN HEALTH
PR4112OtherPREFERRED MEDICARE CHOICE
PR600735OtherMEDICARE Y MUCHO MAS
PR7310340OtherHUMANA HEALTH PLAN
PR7310340OtherHUMANA INSURANCE
PR89564OtherTRIPLE SSS
PR7310340OtherHUMANA INSURANCE