Provider Demographics
NPI:1295265932
Name:RIVAS, FELICIA (TF)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:RIVAS
Suffix:
Gender:F
Credentials:TF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 CALLE SAN FERNANDO
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00982-3615
Mailing Address - Country:US
Mailing Address - Phone:787-257-0968
Mailing Address - Fax:
Practice Address - Street 1:1306 CDT MANUEL DIAZ GARCIA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00908
Practice Address - Country:US
Practice Address - Phone:787-480-3067
Practice Address - Fax:787-721-7596
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4771183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician