Provider Demographics
NPI:1205258811
Name:RIVERA CRUZ, MARIELI
Entity type:Individual
Prefix:
First Name:MARIELI
Middle Name:
Last Name:RIVERA CRUZ
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:URB. ESTANCIAS DEL GOLF CALLE LUIS MORALES #536
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PUERTORICO
Mailing Address - Zip Code:00730
Mailing Address - Country:UM
Mailing Address - Phone:787-226-9887
Mailing Address - Fax:
Practice Address - Street 1:10 CALLE CASIA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00921
Practice Address - Country:UM
Practice Address - Phone:787-641-7582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-16
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057689183500000X, 1835P0018X
PR0061731835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist