Provider Demographics
NPI:1912642836
Name:GARCIA RIVERA, JAN IBRAHIM
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:IBRAHIM
Last Name:GARCIA RIVERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 CALLE KENNEDY
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-3628
Mailing Address - Country:US
Mailing Address - Phone:787-518-9631
Mailing Address - Fax:
Practice Address - Street 1:URB JARD DE CASABLANCA
Practice Address - Street 2:CALLE KENNEDY 141
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-0095
Practice Address - Country:US
Practice Address - Phone:787-518-9631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program