Provider Demographics
NPI:1790800811
Name:RIVERA DIAZ, JOSE RAUL (PHARMACY TECHNICIAN)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:RAUL
Last Name:RIVERA DIAZ
Suffix:
Gender:M
Credentials:PHARMACY TECHNICIAN
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 1818
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-1818
Mailing Address - Country:US
Mailing Address - Phone:787-720-6336
Mailing Address - Fax:
Practice Address - Street 1:ST CECILIO URBINA
Practice Address - Street 2:ANEXO PLAZA DEL MERCADO LOCAL #5
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00970
Practice Address - Country:US
Practice Address - Phone:787-720-6336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1876183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician