Provider Demographics
NPI:1356904072
Name:INESTA RIVERA, JEAN PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:JEAN PAUL
Middle Name:
Last Name:INESTA 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:SUITE 261
Mailing Address - Street 2:PO BOX 19400
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-4000
Mailing Address - Country:US
Mailing Address - Phone:787-406-3197
Mailing Address - Fax:
Practice Address - Street 1:119 OAKFIELD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5779
Practice Address - Country:US
Practice Address - Phone:813-681-5551
Practice Address - Fax:813-916-2944
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22585208D00000X
FL390200000X
PR5039722390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR22585OtherMEDICAL LICENSE
PR5039722OtherDRIVER LICENSE