Provider Demographics
NPI:1407225493
Name:GONZALEZ RIVERA, CYD MARIE
Entity Type:Individual
Prefix:
First Name:CYD
Middle Name:MARIE
Last Name:GONZALEZ 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:RR 1 BOX 3219
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00739
Mailing Address - Country:UM
Mailing Address - Phone:787-428-6648
Mailing Address - Fax:787-875-3550
Practice Address - Street 1:RR 1 BOX 3219
Practice Address - Street 2:
Practice Address - City:CIDRA
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00739
Practice Address - Country:UM
Practice Address - Phone:787-428-6648
Practice Address - Fax:787-875-3550
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-19
Last Update Date:2015-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10667183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician