Provider Demographics
NPI:1275164352
Name:RIVERA, LUZ H (PH)
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:H
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AVE RAMON RIOS ROMAN #112 B
Mailing Address - Street 2:
Mailing Address - City:SABANA SECA
Mailing Address - State:PR
Mailing Address - Zip Code:00952-1072
Mailing Address - Country:US
Mailing Address - Phone:787-794-0716
Mailing Address - Fax:
Practice Address - Street 1:AVE. RAMON RIOS ROMAN #112 B
Practice Address - Street 2:
Practice Address - City:SABANA SECA
Practice Address - State:PR
Practice Address - Zip Code:00952
Practice Address - Country:US
Practice Address - Phone:787-784-0716
Practice Address - Fax:787-230-7806
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR002400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist