Provider Demographics
NPI:1740247907
Name:RIVERA-PIETRI, JOSE LUIS (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:LUIS
Last Name:RIVERA-PIETRI
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 7456
Mailing Address - Street 2:PAMPANOS STATION
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7456
Mailing Address - Country:US
Mailing Address - Phone:787-843-4045
Mailing Address - Fax:787-812-5677
Practice Address - Street 1:NUMBER 2 ANA D PEREZ MARCHAND ST
Practice Address - Street 2:INDUSTRIAL REPARADA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00715
Practice Address - Country:US
Practice Address - Phone:787-840-0052
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4426207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR97277Medicare ID - Type Unspecified
D08708Medicare UPIN