Provider Demographics
NPI:1427550086
Name:PEREZ RIVERA, LILLIAN IVETTE (RPH)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:IVETTE
Last Name:PEREZ RIVERA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 URBANIZACION PARQUE LA ARBOLEDA
Mailing Address - Street 2:BO CAMASEYES
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603
Mailing Address - Country:US
Mailing Address - Phone:787-319-3734
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL BELLA VISTA
Practice Address - Street 2:CARR 349 KM 2.7 CERRO LAS MESAS
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00681
Practice Address - Country:US
Practice Address - Phone:939-545-6698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004065183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1948412OtherPR DRIVERS LICENSE