Provider Demographics
NPI:1568501336
Name:RIVERA, RAFAEL F (BSPH)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:F
Last Name:RIVERA
Suffix:
Gender:M
Credentials:BSPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2058
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-4058
Mailing Address - Country:US
Mailing Address - Phone:787-825-7874
Mailing Address - Fax:787-825-1943
Practice Address - Street 1:CALLE BALDORIOTY 18 - A
Practice Address - Street 2:FARMACIA RAPIDA
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769
Practice Address - Country:US
Practice Address - Phone:787-825-7874
Practice Address - Fax:787-825-1943
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR36153336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR039793200Medicaid