Healthcare Provider Details

I. General information

NPI: 1104924299
Provider Name (Legal Business Name): MRS. MARIA TERESA RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 01/23/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VILLAS DE CIUDAD JARDIN APT E 204
BAYAMON PR
00957
US

IV. Provider business mailing address

VILLAS DE CIUDAD JARDIN APT E 204
BAYAMON PR
00957
US

V. Phone/Fax

Practice location:
  • Phone: 787-740-6910
  • Fax:
Mailing address:
  • Phone: 787-740-6910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number3934
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: