Provider Demographics
NPI:1700559531
Name:RIVERA KIRKCONNELL, JORGE MIGUEL (MD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:MIGUEL
Last Name:RIVERA KIRKCONNELL
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 4339
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-4339
Mailing Address - Country:US
Mailing Address - Phone:787-779-0122
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 4339
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00970-4339
Practice Address - Country:US
Practice Address - Phone:787-779-0122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22810207R00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty