Healthcare Provider Details

I. General information

NPI: 1295265932
Provider Name (Legal Business Name): FELICIA RIVAS TF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 06/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 CDT MANUEL DIAZ GARCIA
SAN JUAN PR
00908
US

IV. Provider business mailing address

295 CALLE SAN FERNANDO
CAROLINA PR
00982-3615
US

V. Phone/Fax

Practice location:
  • Phone: 787-480-3067
  • Fax: 787-721-7596
Mailing address:
  • Phone: 787-257-0968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number4771
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: