MEDICARE: CALEB NEIRA 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	3336C0003X	Community/Retail Pharmacy	07-F-1037	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	07-F-1037	OTHER	PR	LIC. NUMBER

General Provider Information

NPI Number	:	1699808618
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALEB NEIRA RIVERA

Provider Business Mailing Address
First Line	:	PO BOX 14037
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00916-4037
Country	:	US
Telephone Number	:	787-268-6233
Fax Number	:	787-727-6441

Provider Business Practice Location Address
First Line	:	387 CALLE BUENAVENTURA
Second Line	:	ESQ. EDUARDO CONDE
City	:	SANTURCE
State	:	PR
Zip	:	00915-2325
Country	:	US
Telephone Number	:	787-268-6233
Fax Number	:	787-727-6441

Authorized Official
Title or Position	:	CONTROLLER
Name	:	LUIS ROSA
Credential	:
Telephone Number	:	787-268-6233

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	03/07/2023

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Directions to “CALEB NEIRA RIVERA ” Practice Location

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