Healthcare Provider Details

I. General information

NPI: 1720167091
Provider Name (Legal Business Name): RUBEN RIVERA II NURSE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 CALLE ALMACIGO MONTECASINO
TOA ALTA PR
00953-3700
US

IV. Provider business mailing address

P.O. BOX 34310
GUAYNABO PR
00934
US

V. Phone/Fax

Practice location:
  • Phone: 787-707-2176
  • Fax: 787-707-2045
Mailing address:
  • Phone: 787-707-2176
  • Fax: 787-707-2045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number9252836
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: