1205089968 NPI number — MR. FRANK RIVERA TEM

Table of content: MR. FRANK RIVERA TEM (NPI 1205089968)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205089968 NPI number — MR. FRANK RIVERA TEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVERA
Provider First Name:
FRANK
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
TEM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SERVICES
Provider Other First Name:
BLUE STAR
Provider Other Middle Name:
AMBULANCE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1205089968
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 1233
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JAYUYA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00664-1233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-828-2424
Provider Business Mailing Address Fax Number:
787-828-2424

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BO. COLLORES CARRETERA 140 K.M. 8.5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAYUYA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-828-2424
Provider Business Practice Location Address Fax Number:
787-828-2424
Provider Enumeration Date:
10/28/2008

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: 146D00000X , with the licence number:  TCAMB162 , 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: 0059341 . This is a "MEDICARE NUMBER PROVIDER" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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