Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 117768 | FL |
N | 207P00000X | Emergency Physician | 17951 | PR |
N | 208D00000X | General Practice Physician | 17951 | PR |
NPI | 1992999437 |
---|---|
Provider Name | Jose L Rivera Mendez |
First Address | Fort Lauderdale, FL 33316-2510 |
Second Address | Fort Lauderdale, FL 33316-2510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2007 |
Last Update Date | 25/01/2019 |