Provider Demographics
NPI:1396610325
Name:RIVERA MIRABAL UROLOGY LLC
Entity type:Organization
Organization Name:RIVERA MIRABAL UROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:RIVERA MIRABAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-726-1484
Mailing Address - Street 1:SAN JORGE MEDICAL OFFICE BUILDING SUITE 401
Mailing Address - Street 2:SAN JORGE STREET 252
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00912-0000
Mailing Address - Country:US
Mailing Address - Phone:787-726-1484
Mailing Address - Fax:
Practice Address - Street 1:SAN JORGE MEDICAL OFFICE BUILDING SUITE 401
Practice Address - Street 2:SAN JORGE STREET 252
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912-0000
Practice Address - Country:US
Practice Address - Phone:787-726-1484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-08
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty