1770355836 NPI number — MR. EDDIE MANUEL RIVERA SOLIS MSW

Table of content: MR. EDDIE MANUEL RIVERA SOLIS MSW (NPI 1770355836)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770355836 NPI number — MR. EDDIE MANUEL RIVERA SOLIS MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVERA SOLIS
Provider First Name:
EDDIE
Provider Middle Name:
MANUEL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
M

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:
1770355836
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HC 1 BOX 67820
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS PIEDRAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00771-9818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-559-6350
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 921 KM 0.5 BARRIO LA SABANA
Provider Second Line Business Practice Location Address:
CALLE JUAN DE DIOS
Provider Business Practice Location Address City Name:
LAS PIEDRAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-550-6350
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2023

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: 104100000X , with the licence number:  11496 , 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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