Healthcare Provider Details

I. General information

NPI: 1295992469
Provider Name (Legal Business Name): RAFAEL RIVERA RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SAN JOSE ST #300
AIBONITO PR
00705-2021
US

IV. Provider business mailing address

PO BOX 2021
AIBONITO PR
00705-2021
US

V. Phone/Fax

Practice location:
  • Phone: 787-735-3025
  • Fax: 787-735-3021
Mailing address:
  • Phone: 787-735-3025
  • Fax: 787-735-3021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2639
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: