1922201292 NPI number — JOSE E RIVERA-ACOSTA MD

Table of content: JOSE E RIVERA-ACOSTA MD (NPI 1922201292)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922201292 NPI number — JOSE E RIVERA-ACOSTA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVERA-ACOSTA
Provider First Name:
JOSE
Provider Middle Name:
E
Provider Name Prefix Text:
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:
1922201292
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
TORRE MEDICA AUXILIO MUTUO 735 AVE. PONCE DE LEON
Provider Second Line Business Mailing Address:
SUITE 816
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00917-5029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-763-1025
Provider Business Mailing Address Fax Number:
787-763-1035

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
TORRE MEDICA AUXILIO MUTUO, 735 AVE. PONCE DE LEON
Provider Second Line Business Practice Location Address:
SUITE 816
Provider Business Practice Location Address City Name:
SANJUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00917-5029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-763-1025
Provider Business Practice Location Address Fax Number:
787-763-1035
Provider Enumeration Date:
06/06/2007

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: 207R00000X , with the licence number:  17183 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X , with the licence number: 17183 , 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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