Provider Demographics
NPI:1013003433
Name:RIVERA, YOLANDA (LIC)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:963 CALLE PUERTO PRINCIPE
Mailing Address - Street 2:URB LAS AMERICAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-1919
Mailing Address - Country:US
Mailing Address - Phone:787-764-2523
Mailing Address - Fax:
Practice Address - Street 1:851 CALLE LAFAYETTE
Practice Address - Street 2:PDA 20 ESQ SAN RAFAEL
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2627
Practice Address - Country:US
Practice Address - Phone:787-724-3307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3937183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR#3937OtherLICENSE PHARMACIST