Provider Demographics
NPI:1326018854
Name:RIVERA, NILDA E
Entity type:Individual
Prefix:
First Name:NILDA
Middle Name:E
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE RONDA
Mailing Address - Street 2:APTO.1102 VILLA ANDALUCIA SUITES
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-2360
Mailing Address - Country:US
Mailing Address - Phone:787-247-6557
Mailing Address - Fax:
Practice Address - Street 1:D1 CALLE FRONTERA
Practice Address - Street 2:STE 6
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-2578
Practice Address - Country:US
Practice Address - Phone:787-761-7605
Practice Address - Fax:787-755-3252
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4315183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician