MEDICARE: SALVADOR TRINIDAD RIVERA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician	1283	PR

General Provider Information

NPI Number	:	1275121444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALVADOR TRINIDAD RIVERA

Provider Business Mailing Address
First Line	:	1528 CALLE 10 SW
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00921-1527
Country	:	US
Telephone Number	:	787-463-1845
Fax Number	:

Provider Business Practice Location Address
First Line	:	1528 CALLE 10 SW
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00921-1527
Country	:	US
Telephone Number	:	787-463-1845
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2021
Last Update Date	:	01/04/2021

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