Provider Demographics
NPI:1881655587
Name:RIVERA FERNANDEZ, DELMARI (OD)
Entity Type:Individual
Prefix:
First Name:DELMARI
Middle Name:
Last Name:RIVERA FERNANDEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:DELMARIE
Other - Middle Name:FE
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:PMB 540-6017
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-6017
Mailing Address - Country:US
Mailing Address - Phone:787-762-5465
Mailing Address - Fax:787-762-5495
Practice Address - Street 1:AVE MONSERRATE
Practice Address - Street 2:VILLA FONTANA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-5444
Practice Address - Country:US
Practice Address - Phone:787-762-5465
Practice Address - Fax:787-762-5495
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0123152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist