Provider Demographics
NPI:1770582298
Name:RIVERA GUZMAN, JOSE A (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:RIVERA GUZMAN
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 11009
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-2109
Mailing Address - Country:US
Mailing Address - Phone:787-402-1764
Mailing Address - Fax:787-721-2204
Practice Address - Street 1:AVE. ASHFORD, ESQ. WASHINGTON #29
Practice Address - Street 2:SUITE 505 ASHFORD MEDICAL CENTER
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-2300
Practice Address - Country:US
Practice Address - Phone:787-721-2324
Practice Address - Fax:787-721-2204
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13554207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7000006288OtherREMITANCE NO
PR0021011Medicare ID - Type UnspecifiedMEDICARE NO
PR7000006288OtherREMITANCE NO