Provider Demographics
NPI:1811399868
Name:RIVERA REYES, MARIA DIANE
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DIANE
Last Name:RIVERA REYES
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:M12 CALLE 3
Mailing Address - Street 2:URB VILLAS DE LOIZA
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-4266
Mailing Address - Country:US
Mailing Address - Phone:787-328-5852
Mailing Address - Fax:
Practice Address - Street 1:M12 CALLE 3
Practice Address - Street 2:URB VILLAS DE LOIZA
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-4266
Practice Address - Country:US
Practice Address - Phone:787-328-5852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10045937183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician