=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881787356
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VICTOR A. RIVERA, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 109 CALLE GEORGETTI
-----------------------------------------------------
City | NARANJITO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-869-2460
-----------------------------------------------------
Fax | 787-869-0756
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 923
-----------------------------------------------------
City | NARANJITO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00719-0923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-869-2460
-----------------------------------------------------
Fax | 787-869-0756
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. CARLOS A RIVERA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-869-2460
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 07-F-0140
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------