Healthcare Provider Details

I. General information

NPI: 1326018854
Provider Name (Legal Business Name): NILDA E. RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

D1 CALLE FRONTERA STE 6
SAN JUAN PR
00926-2578
US

IV. Provider business mailing address

CALLE RONDA APTO.1102 VILLA ANDALUCIA SUITES
SAN JUAN PR
00926-2360
US

V. Phone/Fax

Practice location:
  • Phone: 787-761-7605
  • Fax: 787-755-3252
Mailing address:
  • Phone: 787-247-6557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number4315
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: