Healthcare Provider Details

I. General information

NPI: 1669881884
Provider Name (Legal Business Name): MISS YVELISSE TOSADO RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2014
Last Update Date: 08/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 AGUEYBANA URB. EL VEDADO
SAN JUAN PR
00681
US

IV. Provider business mailing address

PO BOX 2062
MAYAGUEZ PR
00681
US

V. Phone/Fax

Practice location:
  • Phone: 787-986-0227
  • Fax: 787-834-9408
Mailing address:
  • Phone: 787-986-0227
  • Fax: 787-834-9408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number9628
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: