Provider Demographics
NPI:1124085790
Name:MAYMI RIVERA, JOSE AMADO (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:AMADO
Last Name:MAYMI RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PASEO SAN PABLO STE 410
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-7028
Mailing Address - Country:US
Mailing Address - Phone:787-780-0970
Mailing Address - Fax:787-780-5042
Practice Address - Street 1:100 PASEO SAN PABLO STE 410
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7028
Practice Address - Country:US
Practice Address - Phone:787-780-0970
Practice Address - Fax:787-780-5240
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2020-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7681208800000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR80820Medicare ID - Type UnspecifiedPROVIDER NUMBER