Provider Demographics
NPI:1588123137
Name:RIVERA RAMOS, FABILUZ
Entity type:Individual
Prefix:
First Name:FABILUZ
Middle Name:
Last Name:RIVERA RAMOS
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 1:440 CALLE TABONUCO
Mailing Address - Street 2:URB VISTAS DE RIOS GRANDE II
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745
Mailing Address - Country:US
Mailing Address - Phone:787-564-7733
Mailing Address - Fax:787-400-8686
Practice Address - Street 1:VILLAS DE LOIZA
Practice Address - Street 2:1 CALLE 1
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:787-876-3500
Practice Address - Fax:787-400-8686
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3745183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist