Provider Demographics
NPI:1801335435
Name:RIVERA, PEDRO J SR (RN)
Entity type:Individual
Prefix:MR
First Name:PEDRO
Middle Name:J
Last Name:RIVERA
Suffix:SR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:239 AVE ARTERIAL HOSTOS
Mailing Address - Street 2:SUITE 806
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-1474
Mailing Address - Country:US
Mailing Address - Phone:787-536-0222
Mailing Address - Fax:787-250-8156
Practice Address - Street 1:239 AVE ARTERIAL HOSTOS
Practice Address - Street 2:SUITE 806
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-1474
Practice Address - Country:US
Practice Address - Phone:787-536-0222
Practice Address - Fax:787-250-8156
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14797376G00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No376G00000XNursing Service Related ProvidersNursing Home Administrator