Healthcare Provider Details

I. General information

NPI: 1801335435
Provider Name (Legal Business Name): PEDRO J RIVERA SR. RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2017
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 AVE ARTERIAL HOSTOS SUITE 806
SAN JUAN PR
00918-1474
US

IV. Provider business mailing address

239 AVE ARTERIAL HOSTOS SUITE 806
SAN JUAN PR
00918-1474
US

V. Phone/Fax

Practice location:
  • Phone: 787-536-0222
  • Fax: 787-250-8156
Mailing address:
  • Phone: 787-536-0222
  • Fax: 787-250-8156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number14797
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number14797
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: