Provider Demographics
NPI:1720568769
Name:RIVERA MATOS, ROSANY ANN (RN)
Entity Type:Individual
Prefix:
First Name:ROSANY
Middle Name:ANN
Last Name:RIVERA MATOS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 CALLE HUMACAO SANTA RITA
Mailing Address - Street 2:RIO PIEDRAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00925
Mailing Address - Country:US
Mailing Address - Phone:787-239-9231
Mailing Address - Fax:
Practice Address - Street 1:1010 CALLE HUMACAO SANTA RITA
Practice Address - Street 2:RIO PIEDRAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925
Practice Address - Country:US
Practice Address - Phone:787-239-9231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR86119163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse