Healthcare Provider Details

I. General information

NPI: 1407060718
Provider Name (Legal Business Name): DIANI IVETTE RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB.LOS FLAMMBOYANES 262 MAGA ST
GURABO PR
00778
US

IV. Provider business mailing address

URB.LOS FLAMMBOYANES 262 MAGA ST
GURABO PR
00778
US

V. Phone/Fax

Practice location:
  • Phone: 787-739-0594
  • Fax: 787-274-8477
Mailing address:
  • Phone: 787-739-0594
  • Fax: 787-274-8477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number004778
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: