Provider Demographics
NPI:1912672619
Name:RIVERA, JAIME L (MD)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:L
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JAIME
Other - Middle Name:L
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:HC 1 BOX 6078
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-9616
Mailing Address - Country:US
Mailing Address - Phone:787-445-5222
Mailing Address - Fax:
Practice Address - Street 1:BO LA TEA CALLE B 22
Practice Address - Street 2:
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-445-5222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR022219208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice