1336378074 NPI number — MRS. ANTONIO ALBERTO RIVERA

Table of content: MRS. ANTONIO ALBERTO RIVERA (NPI 1336378074)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336378074 NPI number — MRS. ANTONIO ALBERTO RIVERA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVERA
Provider First Name:
ANTONIO
Provider Middle Name:
ALBERTO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1336378074
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CARR 152 SECTOR PEPE MORALES BO. ANONES
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NARANJITO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-361-9767
Provider Business Mailing Address Fax Number:
787-785-6810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE. MINILLAS CARR 631 KM.2..3 CONDOMINIO BAYAMONTE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-361-9767
Provider Business Practice Location Address Fax Number:
787-785-6810
Provider Enumeration Date:
07/02/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  186406 , 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: 120786 , issued by the state of ( PR ) . This identifiers is of the category "MEDICARE UPIN".