Healthcare Provider Details

I. General information

NPI: 1851632798
Provider Name (Legal Business Name): JUDITH RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2013
Last Update Date: 03/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 AVE SAN JOSE E
AIBONITO PR
00705-3733
US

IV. Provider business mailing address

305 AVE SAN JOSE E
AIBONITO PR
00705-3733
US

V. Phone/Fax

Practice location:
  • Phone: 787-991-7355
  • Fax: 787-991-7361
Mailing address:
  • Phone: 787-991-7355
  • Fax: 787-991-7361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4369
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: