Provider Demographics
NPI:1982114351
Name:PEREZ RIOS, ROSA MATILDE
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:MATILDE
Last Name:PEREZ RIOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:C47 B STREET
Mailing Address - Street 2:EXT ALAMEDA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-485-5156
Mailing Address - Fax:
Practice Address - Street 1:23 CALLE VALLEJO ESQ PINERO LOTE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925-0092
Practice Address - Country:US
Practice Address - Phone:787-771-3584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2922183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist