Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NR0400X | Rehabilitation Chiropractor | 70672 | PR |
NPI | 1255798443 |
---|---|
Provider Name | Jaser Rivera Rivera |
First Address | Ponce, PR 00731 |
Second Address | Ponce, PR 00731 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2016 |
Last Update Date | 20/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
SP0003729 | TRIPLE S (01) | PR |