NPI |
1144809880 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Entity Type Code |
1 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Provider Last Name Legal Name |
RIVERA |
The last name of the provider. If the provider is an individual, this is the legal name. |
Provider First Name |
JOSE |
The last name of the provider. If the provider is an individual, this is the legal name. |
Provider Middle Name |
LUIS |
The middle name of the provider, if the provider
is an individual. |
Provider Name Prefix Text |
MR. |
The middle name of the provider, if the provider
is an individual. |
Provider Name Suffix Text |
JR. |
The name suffix of the provider if the provider
is an individual. The name suffix is a ‘‘generation-related’’ suffix, such as Jr., Sr., II, III, IV, or V. |
Provider First Line Business Practice Location Address |
458 GRAND AVE |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address City Name |
NEW HAVEN |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
CT |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
065133856 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
2037521212 |
The telephone number associated with the location address of the provider being identified. |
Provider Enumeration Date |
4/7/2021 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
4/7/2021 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider Gender Code |
M |
The code designating the provider’s gender if the provider is a person. |
Healthcare Provider Taxonomy Code 1 |
101Y00000X |
The code designating the provider’s gender if the provider is a person. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Sole Proprietor |
N |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
NPI Certification Date |
4/7/2021 |
|