Provider Demographics
NPI:1124378369
Name:PAULINO RIVERA, DIANA A (PHARM D)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:A
Last Name:PAULINO RIVERA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 36 BOX 8124
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-9561
Mailing Address - Country:US
Mailing Address - Phone:787-349-8547
Mailing Address - Fax:
Practice Address - Street 1:150 CALLE F VIZCARRONDO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4483
Practice Address - Country:US
Practice Address - Phone:787-755-1375
Practice Address - Fax:787-755-1340
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5569183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5569Other5569