=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184831257
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RUTH DELLY PEREZ RIVERA PHARMACY TECHNICIAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | RAMOS ANTONINI 104 E
-----------------------------------------------------
City | MAYAGUEZ
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00680
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-832-3284
-----------------------------------------------------
Fax | 787-832-3284
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4051
-----------------------------------------------------
City | MAYAGUEZ
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00681-4051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-464-3835
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | AX2500
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------