Provider Demographics
NPI:1760144505
Name:RIVERA VEGA, PEDRO ANTONIO (RN)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:ANTONIO
Last Name:RIVERA VEGA
Suffix:
Gender:M
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:HC 1 BOX 4487
Mailing Address - Street 2:
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767-9643
Mailing Address - Country:US
Mailing Address - Phone:787-365-9736
Mailing Address - Fax:
Practice Address - Street 1:121 CALLE CRUZ ORTIZ STELLA S
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3727
Practice Address - Country:US
Practice Address - Phone:787-450-3075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR91234163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse