Provider Demographics
NPI:1205089968
Name:RIVERA, FRANK (TEM)
Entity type:Individual
Prefix:MR
First Name:FRANK
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:TEM
Other - Prefix:
Other - First Name:BLUE STAR
Other - Middle Name:AMBULANCE
Other - Last Name:SERVICES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1233
Mailing Address - Street 2:
Mailing Address - City:JAYUYA
Mailing Address - State:PR
Mailing Address - Zip Code:00664-1233
Mailing Address - Country:US
Mailing Address - Phone:787-828-2424
Mailing Address - Fax:787-828-2424
Practice Address - Street 1:BO. COLLORES CARRETERA 140 K.M. 8.5
Practice Address - Street 2:
Practice Address - City:JAYUYA
Practice Address - State:PR
Practice Address - Zip Code:00664
Practice Address - Country:US
Practice Address - Phone:787-828-2424
Practice Address - Fax:787-828-2424
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTCAMB162146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0059341OtherMEDICARE NUMBER PROVIDER