Provider Demographics
NPI:1184965717
Name:RIVERA, JESSICA (MD)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EMBALSE SAN JOSE
Mailing Address - Street 2:CALAF 371
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00923-1347
Mailing Address - Country:US
Mailing Address - Phone:939-276-9039
Mailing Address - Fax:
Practice Address - Street 1:371 CALLE CALAF
Practice Address - Street 2:EMBALSE SAN JOSE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-1347
Practice Address - Country:US
Practice Address - Phone:939-276-9039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8665183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR8665OtherLICENSE