Provider Demographics
NPI:1679196026
Name:RIVERA, FLORENTINO I
Entity Type:Individual
Prefix:
First Name:FLORENTINO
Middle Name:
Last Name:RIVERA
Suffix:I
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:PO BOX 41
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-0041
Mailing Address - Country:US
Mailing Address - Phone:787-934-1895
Mailing Address - Fax:787-957-5478
Practice Address - Street 1:Z1 AVE CARLOS J ANDALUZ
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-785-2458
Practice Address - Fax:787-957-5478
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16513336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy