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General NPI Number Information
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NPI Number | 1588909915
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Entity Type | Organization
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Legal Business Name | RIVERA-REVILLA LAB LLC
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Dates
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Enumeration Date | 12/12/2012
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Last Update Date | 11/20/2013
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Provider Practice Location Address
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Address Line | PLAZA GUZMAN AVE 65 INS KM 11.0
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City | CAROLINA
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State | PR
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Zip | 00985
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Country | US
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Telephone | 787-691-9595
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Fax |
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Provider Business Mailing Address
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Address Line | MANS DE CAROLINA MARQUESA ST #GG-6
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City | CAROLINA
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State | PR
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Zip | 00987
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Country | US
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Telephone | 787-768-3400
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. YENIRMA RIVERA
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Credential |
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Telephone | 787-768-3400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 1293
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License Number State | PR
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