Provider Demographics
NPI:1447390794
Name:RIVERA, ARNALDO L
Entity Type:Individual
Prefix:MR
First Name:ARNALDO
Middle Name:L
Last Name:RIVERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BP23 CALLE 117
Mailing Address - Street 2:JARDINEZ DE COUNTRY CLUB
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983-2111
Mailing Address - Country:US
Mailing Address - Phone:787-726-0295
Mailing Address - Fax:787-726-8768
Practice Address - Street 1:2428 CALLE LOIZA
Practice Address - Street 2:PUNTA LAS MARIAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00913-4731
Practice Address - Country:US
Practice Address - Phone:787-726-0295
Practice Address - Fax:787-726-8768
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5679183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5679OtherPHARMACY TECHNICIAN