1447211677 NPI number — DR. JORGE LUIS RIVERA-HERRERA MD

Table of content: DR. JORGE LUIS RIVERA-HERRERA MD (NPI 1447211677)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447211677 NPI number — DR. JORGE LUIS RIVERA-HERRERA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVERA-HERRERA
Provider First Name:
JORGE
Provider Middle Name:
LUIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1447211677
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
SAN JORGE MEDICAL OFFICE BUILDING . 401
Provider Second Line Business Mailing Address:
SAN JORGE AVE. 252
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-726-1484
Provider Business Mailing Address Fax Number:
787-268-0972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
COND SAN JORGE # 252
Provider Second Line Business Practice Location Address:
SAN JORGE MEDICAL OFFICE BUILDING SUITE 401
Provider Business Practice Location Address City Name:
SANTURCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00912-3359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-726-1484
Provider Business Practice Location Address Fax Number:
787-268-0972
Provider Enumeration Date:
03/29/2006

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: 208800000X , with the licence number:  11152 , 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)





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