Provider Demographics
NPI:1780279885
Name:VELEZ RIVIE, DIANE (CPHT)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:VELEZ RIVIE
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VILLA DEL ESTE 1365
Mailing Address - Street 2:CARR 203 APT 225
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:787-429-0028
Mailing Address - Fax:
Practice Address - Street 1:200 GRAND BLVD LOS PRADOS STE 785
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-9533
Practice Address - Country:US
Practice Address - Phone:787-744-2347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8971183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician