Provider Demographics
NPI:1225167877
Name:RIVERA, ILIA ANGELICA
Entity Type:Individual
Prefix:
First Name:ILIA
Middle Name:ANGELICA
Last Name:RIVERA
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:CALLE 2 # 36 FLAMINGO HILLS
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957-1717
Mailing Address - Country:US
Mailing Address - Phone:787-646-2968
Mailing Address - Fax:
Practice Address - Street 1:AVE. LOMAS VERDES, EDIF., UNIVERSIDAD PHOENIX
Practice Address - Street 2:CARRETERA 177, KM. 2.0
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-272-4998
Practice Address - Fax:787-272-4969
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0615183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0615OtherPHARMACIST THECNICIAN