Provider Demographics
NPI:1871718403
Name:RIVERA, EDNA BEATRIZ
Entity type:Individual
Prefix:
First Name:EDNA
Middle Name:BEATRIZ
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:PO BOX 1032
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-1032
Mailing Address - Country:US
Mailing Address - Phone:787-863-0063
Mailing Address - Fax:
Practice Address - Street 1:CALLE UNION #1 ESQ.
Practice Address - Street 2:URB. SANTA ISIDRA
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-863-2070
Practice Address - Fax:787-860-0259
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1639183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist