1699808618 NPI number — CALEB NEIRA RIVERA

Table of content: (NPI 1699808618)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699808618 NPI number — CALEB NEIRA RIVERA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALEB NEIRA RIVERA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FARMACIA ARCHILLA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699808618
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 14037
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00916-4037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-268-6233
Provider Business Mailing Address Fax Number:
787-727-6441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
387 CALLE BUENAVENTURA
Provider Second Line Business Practice Location Address:
ESQ. EDUARDO CONDE
Provider Business Practice Location Address City Name:
SANTURCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00915-2325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-268-6233
Provider Business Practice Location Address Fax Number:
787-727-6441
Provider Enumeration Date:
03/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROSA
Authorized Official First Name:
LUIS
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
787-268-6233

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  07-F-1037 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 07-F-1037 . This is a "LIC. NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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