Provider Demographics
NPI:1336358415
Name:RIERA RODRIGUEZ, JOSE D (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:D
Last Name:RIERA RODRIGUEZ
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 1:29 CALLE WASHINGTON
Mailing Address - Street 2:ASHFORD MEDICAL CTR SUITE 204
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1509
Mailing Address - Country:US
Mailing Address - Phone:787-724-2977
Mailing Address - Fax:787-723-4406
Practice Address - Street 1:29 CALLE WASHINGTON
Practice Address - Street 2:ASHFORD MEDICAL CTR SUITE 204
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1510
Practice Address - Country:US
Practice Address - Phone:787-724-2977
Practice Address - Fax:787-723-4406
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR002878174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2878OtherMEDICAL LICENSE
PR9-2592Medicare UPIN
PRA.R. 9285289Medicare ID - Type Unspecified