Provider Demographics
NPI:1871284091
Name:VALENTIN RIVERA, JAILEEN
Entity type:Individual
Prefix:
First Name:JAILEEN
Middle Name:
Last Name:VALENTIN 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:PO BOX 3390
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-3390
Mailing Address - Country:US
Mailing Address - Phone:787-560-0553
Mailing Address - Fax:
Practice Address - Street 1:1 CALLE MAGNOLIA STE 2
Practice Address - Street 2:
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784-6301
Practice Address - Country:US
Practice Address - Phone:787-864-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8061183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist