1437257110 NPI number — VIRGILIO CRUZ RIVERA

Table of content: (NPI 1437257110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437257110 NPI number — VIRGILIO CRUZ RIVERA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VIRGILIO CRUZ 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 DEL PILAR
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:
1437257110
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1770
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JUNCOS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00777-1770
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-734-2186
Provider Business Mailing Address Fax Number:
787-734-2186

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE TEODOMIRO DELFAU
Provider Second Line Business Practice Location Address:
STE 26
Provider Business Practice Location Address City Name:
JUNCOS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-734-2186
Provider Business Practice Location Address Fax Number:
787-734-2186
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RIVERA
Authorized Official First Name:
VIRGILLO
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
787-734-2186

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 11F1334 , 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: 4012326 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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