Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 17058 | PR |
NPI | 1023282795 |
---|---|
Provider Name | Jorge Luis Rivera |
First Address | Mayaguez, PR 00682-7788 |
Second Address | Mayaguez, PR 00680 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2008 |
Last Update Date | 10/12/2021 |