Provider Demographics
NPI:1053327031
Name:RIVERA, DANNY SR (AMBULANCE)
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:
Last Name:RIVERA
Suffix:SR
Gender:M
Credentials:AMBULANCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 45 BOX 14551
Mailing Address - Street 2:CARR 171 BO RINCON VILLAS DE MONTE SOL
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-9758
Mailing Address - Country:US
Mailing Address - Phone:787-477-9417
Mailing Address - Fax:787-271-1217
Practice Address - Street 1:HC 45 BOX 14551
Practice Address - Street 2:CARR 171 BO RINCON VILLAS DE MONTE SOL
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-9758
Practice Address - Country:US
Practice Address - Phone:787-477-9417
Practice Address - Fax:787-271-1217
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC AMB 1683416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0059312Medicare ID - Type UnspecifiedAMBULANCE SERVICE