Provider Demographics
NPI:1932334364
Name:BURGOS RIVERA, JORGE A (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:A
Last Name:BURGOS RIVERA
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 1:23 CALLE BARCELO
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-3441
Mailing Address - Country:US
Mailing Address - Phone:787-714-0144
Mailing Address - Fax:787-714-0230
Practice Address - Street 1:23 CALLE BARCELO
Practice Address - Street 2:
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739-3441
Practice Address - Country:US
Practice Address - Phone:787-714-0144
Practice Address - Fax:787-714-0230
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-29
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9632208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG04556Medicare UPIN
PR0081682Medicare PIN