Basic Information
Provider Information
NPI: 1881736270
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RIVERA
FirstName: SONIA
MiddleName: LIGIA
NamePrefix:  
NameSuffix:  
Credential: R.PH.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: URB.TURABO GARDENS CALLE 43 M-1
Address2:  
City: CAGUAS
State: PR
PostalCode: 007276627
CountryCode: US
TelephoneNumber: 7877447605
FaxNumber:  
Practice Location
Address1: AVE. LUIS MUNOZ MARIN
Address2: APARTADO 4980
City: CAGUAS
State: PR
PostalCode: 007264980
CountryCode: US
TelephoneNumber: 7876533434
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/13/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
183500000X1939PRY Pharmacy Service ProvidersPharmacist 

No ID Information.


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