1295086569 NPI number — ANDRES RIVERA PACHECO

Table of content: (NPI 1295086569)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295086569 NPI number — ANDRES RIVERA PACHECO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANDRES RIVERA PACHECO
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:
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:
1295086569
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MG20 PLAZA 40
Provider Second Line Business Mailing Address:
MARINA BAHIA
Provider Business Mailing Address City Name:
CATANO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00962-6786
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-820-4622
Provider Business Mailing Address Fax Number:
787-820-4622

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CALLE IGUINA
Provider Second Line Business Practice Location Address:
# 3
Provider Business Practice Location Address City Name:
CAMUY
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-820-4622
Provider Business Practice Location Address Fax Number:
787-820-4622
Provider Enumeration Date:
09/27/2012

Additional Information

Authorized Official

Authorized Official Last Name:
RIVERA
Authorized Official First Name:
ANDRES
Authorized Official Middle Name:
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
787-820-4622

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  210 , 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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