Provider Demographics
NPI:1043051097
Name:RIVERA, JOMARIE
Entity type:Individual
Prefix:
First Name:JOMARIE
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 CARR 14
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-2163
Mailing Address - Country:US
Mailing Address - Phone:787-651-0448
Mailing Address - Fax:787-842-0411
Practice Address - Street 1:1800 CARR 14
Practice Address - Street 2:
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780-2163
Practice Address - Country:US
Practice Address - Phone:787-651-0448
Practice Address - Fax:787-842-0411
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR818156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician