Healthcare Provider Details

I. General information

NPI: 1770189102
Provider Name (Legal Business Name): JOSE ORLANDO RIVERA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DR. JOSE O RIVERA-ORTIZ

II. Dates (important events)

Enumeration Date: 12/10/2020
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N CAMPBELL ST STE 110
EL PASO TX
79902-4238
US

IV. Provider business mailing address

1101 N CAMPBELL ST STE 110
EL PASO TX
79902-4238
US

V. Phone/Fax

Practice location:
  • Phone: 915-747-8519
  • Fax: 915-747-8521
Mailing address:
  • Phone: 915-747-8519
  • Fax: 915-747-8521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number35392
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: