Provider Demographics
NPI:1780046623
Name:RIVERA, MIRIAM VANESSA
Entity Type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:VANESSA
Last Name:RIVERA
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 5340
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00971-9514
Mailing Address - Country:US
Mailing Address - Phone:787-614-2606
Mailing Address - Fax:787-723-4068
Practice Address - Street 1:900 CALLE CERRA
Practice Address - Street 2:PARADA 15 FINAL
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-722-4600
Practice Address - Fax:787-723-4068
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-21
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9874183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician