1043772130 NPI number — DR. JOMARIE ORTIZ RIVERA PHARMD

Table of content: DR. JOMARIE ORTIZ RIVERA PHARMD (NPI 1043772130)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043772130 NPI number — DR. JOMARIE ORTIZ RIVERA PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ORTIZ RIVERA
Provider First Name:
JOMARIE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

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:
1043772130
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
A5 CALLE 1
Provider Second Line Business Mailing Address:
VILLA CRISTINA
Provider Business Mailing Address City Name:
COAMO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00769
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-478-0215
Provider Business Mailing Address Fax Number:
787-825-2290

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 153 KM 6.9 INT PLAZA OASIS
Provider Second Line Business Practice Location Address:
BO FELICIA SECTOR PASO SECO
Provider Business Practice Location Address City Name:
SANTA ISABEL
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-845-6272
Provider Business Practice Location Address Fax Number:
787-825-2290
Provider Enumeration Date:
04/05/2019

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: 183500000X , with the licence number:  006639 , 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)





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