Provider Demographics
NPI:1205365251
Name:RIVERA-RODRIGUEZ, YOVALERY
Entity Type:Individual
Prefix:
First Name:YOVALERY
Middle Name:
Last Name:RIVERA-RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CALLE F
Mailing Address - Street 2:SANTA ROSA
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-1610
Mailing Address - Country:US
Mailing Address - Phone:787-201-3456
Mailing Address - Fax:787-289-2515
Practice Address - Street 1:1307 AVE ASHFORD
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1325
Practice Address - Country:US
Practice Address - Phone:787-289-2510
Practice Address - Fax:787-289-2515
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR06328183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist