Provider Demographics
NPI:1013123793
Name:RIVERA COLON, JOSE O (4964)
Entity Type:Individual
Prefix:MS
First Name:JOSE
Middle Name:O
Last Name:RIVERA COLON
Suffix:
Gender:M
Credentials:4964
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC-4 BOX 8301
Mailing Address - Street 2:
Mailing Address - City:COMERIO
Mailing Address - State:PR
Mailing Address - Zip Code:00782
Mailing Address - Country:US
Mailing Address - Phone:787-317-4042
Mailing Address - Fax:
Practice Address - Street 1:HC 4 BOX 8301
Practice Address - Street 2:
Practice Address - City:COMERIO
Practice Address - State:PR
Practice Address - Zip Code:00782-9739
Practice Address - Country:US
Practice Address - Phone:787-317-4042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4964183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4964Other4964