Provider Demographics
NPI:1871744482
Name:RIVERA, JO BETHER (MD)
Entity type:Individual
Prefix:DR
First Name:JO
Middle Name:BETHER
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18544 CHERRY LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-5345
Mailing Address - Country:US
Mailing Address - Phone:301-869-3294
Mailing Address - Fax:240-477-4071
Practice Address - Street 1:2638 CALLE PONTEVEDRA
Practice Address - Street 2:URB. JARDINES FAGOT
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-3614
Practice Address - Country:US
Practice Address - Phone:787-843-4754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14761171R00000X, 251V00000X, 261Q00000X, 261QC1500X, 261QC1800X, 261QH0100X, 261QP2300X, 261QX0100X, 302R00000X, 305R00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No171R00000XOther Service ProvidersInterpreter
No251V00000XAgenciesVoluntary or Charitable
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program