1497742316 NPI number — DR. JOSE SANDALIO RIVERA IRIZARRY M.D.

Table of content: DANIEL YATS ATC (NPI 1457850406)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497742316 NPI number — DR. JOSE SANDALIO RIVERA IRIZARRY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVERA IRIZARRY
Provider First Name:
JOSE
Provider Middle Name:
SANDALIO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497742316
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
339 CYPRESS PKWY
Provider Second Line Business Mailing Address:
STE 110
Provider Business Mailing Address City Name:
KISSIMMEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34759-3315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-343-5000
Provider Business Mailing Address Fax Number:
407-343-5199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
211 CALLE MORSE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARROYO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00714-2350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-839-3980
Provider Business Practice Location Address Fax Number:
787-271-2515
Provider Enumeration Date:
10/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  11901 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: JSRI-819 . This is a "MENONITA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: N-752 . This is a "INTERNATINAL MEDICAL CARD" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 400330 . This is a "MEDICARE Y MUCHO MAS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 87929 . This is a "TRIPLE - S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 0010804 . This is a "HUMANA HEALTH PLANS (PR)" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 03286 . This is a "AMERICAN HEALTH, INC." identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1-2073-1 . This is a "ACAA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 111545100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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