Provider Demographics
NPI:1861573677
Name:RIVERA VALLES, JOSE ANTONIO (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ANTONIO
Last Name:RIVERA VALLES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 194535
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-4535
Mailing Address - Country:US
Mailing Address - Phone:787-420-6331
Mailing Address - Fax:787-799-6308
Practice Address - Street 1:AVE AMERICO MIRANDA ESQ CENTRO MEDICO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00935-0001
Practice Address - Country:US
Practice Address - Phone:787-420-6331
Practice Address - Fax:939-336-9598
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2023-02-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR14709207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0021729Medicare PIN