1881787356 NPI number — VICTOR A. RIVERA, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881787356 NPI number — VICTOR A. RIVERA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VICTOR A. RIVERA, INC.
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 SAN MIGUEL
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:
1881787356
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 923
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:
00719-0923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-869-2460
Provider Business Mailing Address Fax Number:
787-869-0756

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
109 CALLE GEORGETTI
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NARANJITO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-869-2460
Provider Business Practice Location Address Fax Number:
787-869-0756
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RIVERA
Authorized Official First Name:
CARLOS
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
787-869-2460

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  07-F-0140 , 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: 4004773 . This is a "NCPDP NUMBER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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