Provider Demographics
NPI:1588839765
Name:RIVERA-CRUZ, ABIMAEL (MD RPH)
Entity Type:Individual
Prefix:
First Name:ABIMAEL
Middle Name:
Last Name:RIVERA-CRUZ
Suffix:
Gender:M
Credentials:MD RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 AVE MIRAMAR STE 2
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-4366
Mailing Address - Country:US
Mailing Address - Phone:787-956-0020
Mailing Address - Fax:787-956-0018
Practice Address - Street 1:540 AVE MIRAMAR STE 2
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4366
Practice Address - Country:US
Practice Address - Phone:787-956-0020
Practice Address - Fax:787-956-0018
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5112183500000X
FLPS39927183500000X
PR18797207N00000X
FLME112838207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No183500000XPharmacy Service ProvidersPharmacist