Provider Demographics
NPI:1184831257
Name:PEREZ RIVERA, RUTH DELLY (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:DELLY
Last Name:PEREZ RIVERA
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4051
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-4051
Mailing Address - Country:US
Mailing Address - Phone:787-464-3835
Mailing Address - Fax:
Practice Address - Street 1:RAMOS ANTONINI 104 E
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-832-3284
Practice Address - Fax:787-832-3284
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRAX2500363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRAX2500OtherPHARMACY TECHNICIAN