Provider Demographics
NPI:1316978141
Name:RIVERO, JESUS (MD)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:RIVERO
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:PO BOX 3047
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-3047
Mailing Address - Country:US
Mailing Address - Phone:787-948-7404
Mailing Address - Fax:
Practice Address - Street 1:CAROLINA SHOPPING COURT
Practice Address - Street 2:SUITE 311 6TH FLOOR
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00986
Practice Address - Country:US
Practice Address - Phone:787-276-8763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR162562084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI-62419Medicare UPIN
PR2-4689Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER