Provider Demographics
NPI:1811611049
Name:RIVERA VEGA, JESUS RAFAEL
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:RAFAEL
Last Name:RIVERA VEGA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARRETERA 6618 KM 0.9 HECTOMETRO 1 BO MOROVIS SUR
Mailing Address - Street 2:
Mailing Address - City:MOROVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00687
Mailing Address - Country:US
Mailing Address - Phone:787-201-3130
Mailing Address - Fax:
Practice Address - Street 1:CARR 6618 KM 0.9 HECTOMETRO 1 BO MMOROVIS SUR
Practice Address - Street 2:
Practice Address - City:MOROVIS
Practice Address - State:PR
Practice Address - Zip Code:00687-0068
Practice Address - Country:US
Practice Address - Phone:787-201-3130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-30
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR98722163WW0000X
174H00000X, 332BP3500X, 332BX2000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No174H00000XOther Service ProvidersHealth Educator
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies