Provider Demographics
NPI:1528843968
Name:RIVERA DIAZ, VICTORIA SAMANTHA
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:SAMANTHA
Last Name:RIVERA DIAZ
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 1:343 EXT VISTAS DE CAMUY
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-2939
Mailing Address - Country:US
Mailing Address - Phone:787-515-3437
Mailing Address - Fax:
Practice Address - Street 1:685 CALLE CESAR GONZALEZ
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3920
Practice Address - Country:US
Practice Address - Phone:787-294-1730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-25
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2880390200000X
PR8439183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program