Healthcare Provider Details

I. General information

NPI: 1801031596
Provider Name (Legal Business Name): ADRIAN N. VICENTY RIVERA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2008
Last Update Date: 09/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE 12 NUMERO 38 COMUNIDAD ELIZABETH BO. PUERTO REAL
CABO ROJO PR
00623
US

IV. Provider business mailing address

P.O. BOX 799
HORMIGUEROS PR
00660
US

V. Phone/Fax

Practice location:
  • Phone: 787-851-4501
  • Fax: 787-851-4501
Mailing address:
  • Phone: 787-851-4501
  • Fax: 787-851-4501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number1171
License Number StatePR

VIII. Authorized Official

Name: MR. ADRIAN VICENTY RIVERA
Title or Position: SUPERVISOR(OWNER)
Credential: M.T
Phone: 787-851-4501