Provider Demographics
NPI:1285635151
Name:RIVERA-ROSA, CARMEN M (OPTICIAN)
Entity type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:M
Last Name:RIVERA-ROSA
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46-AR-8 VALLE ARRIBA HEIGHTS
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983
Mailing Address - Country:US
Mailing Address - Phone:787-765-2722
Mailing Address - Fax:787-765-2771
Practice Address - Street 1:1699 CALLE PARANA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-3143
Practice Address - Country:US
Practice Address - Phone:787-765-2722
Practice Address - Fax:787-765-2771
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR100156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR89010OtherMEDICARE
PR051359OtherLA CRUZ AZUL DEPR
PR051359OtherLA CRUZ AZUL DEPR
PR89010OtherMEDICARE