Provider Demographics
NPI:1457645061
Name:RIVERA, CARMEN CARELIS
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:CARELIS
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 REYNA MORA 2001
Mailing Address - Street 2:URBANIZACION HACIENDA EL PILAR
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-9421
Mailing Address - Country:US
Mailing Address - Phone:787-568-9051
Mailing Address - Fax:787-780-8426
Practice Address - Street 1:PR 2 & PR 866
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-780-8426
Practice Address - Fax:787-780-8486
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5125183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist