Provider Demographics
NPI:1649309162
Name:RIVERA, ARNALDO
Entity type:Individual
Prefix:MR
First Name:ARNALDO
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ARNALDO
Other - Middle Name:
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:# 403 GRAN AUSUBO STREET
Mailing Address - Street 2:CIUDAD JARDIN 3
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:787-778-2957
Mailing Address - Fax:787-778-2957
Practice Address - Street 1:403 GRAN AUSUBO STREET
Practice Address - Street 2:CIUDAD JARDIN 3
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00953
Practice Address - Country:US
Practice Address - Phone:787-778-2957
Practice Address - Fax:787-778-2957
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR627152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR53581OtherPROVIDER