Provider Demographics
NPI:1134457146
Name:RIVERA, PEDRO J (LPN)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:J
Last Name:RIVERA
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PARK VIEW TER
Mailing Address - Street 2:LOIZA VALLEY
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-3522
Mailing Address - Country:US
Mailing Address - Phone:787-309-1519
Mailing Address - Fax:
Practice Address - Street 1:PARK VIEW TER
Practice Address - Street 2:LOIZA VALLEY
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-3522
Practice Address - Country:US
Practice Address - Phone:787-309-1519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14904164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse