Provider Demographics
NPI:1598802084
Name:RIVERA-BURGOS, SHERLY ANN
Entity Type:Individual
Prefix:
First Name:SHERLY
Middle Name:ANN
Last Name:RIVERA-BURGOS
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:HC 4 BOX 6898
Mailing Address - Street 2:
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767-9510
Mailing Address - Country:US
Mailing Address - Phone:787-475-5638
Mailing Address - Fax:
Practice Address - Street 1:37 CALLE CRISTOBAL COLON
Practice Address - Street 2:
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767-3324
Practice Address - Country:US
Practice Address - Phone:787-893-2440
Practice Address - Fax:787-893-2440
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4774183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4774OtherPHARMACY TECH LIC PR