MEDICARE: DIANA RIVERA CORREA R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5157	PR

General Provider Information

NPI Number	:	1134349459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA RIVERA CORREA R.PH.

Provider Business Mailing Address
First Line	:	URB. EL MADRIGAL 610 CALLE CIPRES
Second Line	:
City	:	PENUELAS
State	:	PR
Zip	:	00624
Country	:	US
Telephone Number	:	787-836-7643
Fax Number	:

Provider Business Practice Location Address
First Line	:	SAN CRISTOBAL PLZ
Second Line	:	COTO LAUREL
City	:	PONCE
State	:	PR
Zip	:	00780-2929
Country	:	US
Telephone Number	:	787-848-2100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2007
Last Update Date	:	07/08/2007

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