Provider Demographics
NPI:1811163843
Name:RIVERA SANTIAGO, JOSE A (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:RIVERA SANTIAGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:246 CALLE RAMOS ANTONINI
Mailing Address - Street 2:URB PONCE DE LEON
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-5135
Mailing Address - Country:US
Mailing Address - Phone:787-832-4545
Mailing Address - Fax:787-834-1228
Practice Address - Street 1:CPR BUILDING
Practice Address - Street 2:SUITE 102
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-832-4545
Practice Address - Fax:787-834-1228
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2016-08-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR11060207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG41001Medicare UPIN
PR0088486Medicare PIN