Provider Demographics
NPI:1851072052
Name:RIVERA, IRIS JANET
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:JANET
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 1:400 AVE LA SIERRA # 177
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4351
Mailing Address - Country:US
Mailing Address - Phone:787-292-2050
Mailing Address - Fax:787-755-6835
Practice Address - Street 1:400 AVE LA SIERRA # 177
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4351
Practice Address - Country:US
Practice Address - Phone:787-292-2050
Practice Address - Fax:787-755-6836
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8667183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician