Provider Demographics
NPI:1285378315
Name:RIVERA GONZALEZ, CAROLINA ALEJANDRA (PHARMD)
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:ALEJANDRA
Last Name:RIVERA GONZALEZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:G 103 CALLE REINA ISABEL MANSIONES EN PASEO DE REYES
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795
Mailing Address - Country:US
Mailing Address - Phone:787-955-5829
Mailing Address - Fax:
Practice Address - Street 1:367 CALLE VICTORIA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-3473
Practice Address - Country:US
Practice Address - Phone:787-905-2015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR006942183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist