Provider Demographics
NPI:1174665269
Name:RIVERA, JOSE LUIS
Entity Type:Individual
Prefix:
First Name:JOSE LUIS
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
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 25 BLOQUE 25 NUM. 19 SIERRA BAYAMON
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-269-1579
Mailing Address - Fax:
Practice Address - Street 1:FARMACIA CLINICA LAS AMERICAS
Practice Address - Street 2:AVENIDA ROOSVELT # 400 SUITE 102
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-764-3520
Practice Address - Fax:787-764-4011
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2976183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist