MEDICARE: RUBEN RIVERA II NURSE

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	163WA2000X	Administrator Registered Nurse	9252836	FL

General Provider Information

NPI Number	:	1720167091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUBEN RIVERA II NURSE

Provider Business Mailing Address
First Line	:	P.O. BOX 34310
Second Line	:
City	:	GUAYNABO
State	:	PR
Zip	:	00934
Country	:	US
Telephone Number	:	787-707-2176
Fax Number	:	787-707-2045

Provider Business Practice Location Address
First Line	:	327 CALLE ALMACIGO
Second Line	:	MONTECASINO
City	:	TOA ALTA
State	:	PR
Zip	:	00953-3700
Country	:	US
Telephone Number	:	787-707-2176
Fax Number	:	787-707-2045

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/08/2007

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