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General NPI Number Information
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NPI Number | 1801031596
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Entity Type | Organization
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Legal Business Name | ADRIAN N. VICENTY RIVERA
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Dates
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Enumeration Date | 12/09/2008
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Last Update Date | 09/03/2009
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Provider Practice Location Address
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Address Line | CALLE 12 NUMERO 38 COMUNIDAD ELIZABETH BO. PUERTO REAL
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City | CABO ROJO
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State | PR
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Zip | 00623
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Country | US
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Telephone | 787-851-4501
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Fax | 787-851-4501
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Provider Business Mailing Address
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Address Line | P.O. BOX 799
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City | HORMIGUEROS
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State | PR
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Zip | 00660
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Country | US
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Telephone | 787-851-4501
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Fax | 787-851-4501
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Authorized Official
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Title or Position | SUPERVISOR(OWNER)
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Name | MR. ADRIAN VICENTY RIVERA
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Credential | M.T
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Telephone | 787-851-4501
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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 | 1171
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License Number State | PR
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