Provider Demographics
NPI:1942886627
Name:ZAYAS RIVERA, KISHA MARIE
Entity Type:Individual
Prefix:
First Name:KISHA
Middle Name:MARIE
Last Name:ZAYAS 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 3 BOX 7998
Mailing Address - Street 2:
Mailing Address - City:BARRANQUITAS
Mailing Address - State:PR
Mailing Address - Zip Code:00794-8583
Mailing Address - Country:US
Mailing Address - Phone:787-519-2062
Mailing Address - Fax:
Practice Address - Street 1:2114 CARR 2
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-4849
Practice Address - Country:US
Practice Address - Phone:787-740-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR013359183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician