Provider Demographics
NPI:1063974301
Name:RIVERA, HECTOR FRANCISCO
Entity type:Individual
Prefix:
First Name:HECTOR
Middle Name:FRANCISCO
Last Name:RIVERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2331
Mailing Address - Street 2:
Mailing Address - City:UTUADO
Mailing Address - State:PR
Mailing Address - Zip Code:00641-2331
Mailing Address - Country:US
Mailing Address - Phone:787-894-2075
Mailing Address - Fax:787-894-6272
Practice Address - Street 1:21 CALLE BARCELO
Practice Address - Street 2:
Practice Address - City:UTUADO
Practice Address - State:PR
Practice Address - Zip Code:00641-2902
Practice Address - Country:US
Practice Address - Phone:787-894-2075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR006252183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR006252Medicaid