Provider Demographics
NPI:1952975278
Name:RIVERA, JOSE JR (FNP-BC)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:RIVERA
Suffix:JR
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20515 ALBRITTON TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-8601
Mailing Address - Country:US
Mailing Address - Phone:832-746-3945
Mailing Address - Fax:
Practice Address - Street 1:4710 BELLAIRE BLVD STE 250
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4531
Practice Address - Country:US
Practice Address - Phone:713-441-9040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1018541363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
1018541OtherPRIVATE INSURANCE