Provider Demographics
NPI:1184893877
Name:RIVERA, OLGA
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:
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:PO BOX 1741
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-1741
Mailing Address - Country:US
Mailing Address - Phone:787-854-3570
Mailing Address - Fax:787-854-3565
Practice Address - Street 1:EDIF PUERTA DEL NORTE
Practice Address - Street 2:SUITE NUM 5
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-1741
Practice Address - Country:US
Practice Address - Phone:787-854-3570
Practice Address - Fax:787-854-3565
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1484246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR38364Medicare PIN