Provider Demographics
NPI:1164014163
Name:RIVERA, DIANA (PHARMD)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PORTICOS DE GUAYNABO 3401
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00971
Mailing Address - Country:US
Mailing Address - Phone:787-485-8439
Mailing Address - Fax:
Practice Address - Street 1:400 AVE LA SIERRA # 177
Practice Address - Street 2:
Practice Address - City:CUPEY
Practice Address - State:PR
Practice Address - Zip Code:00926-4351
Practice Address - Country:US
Practice Address - Phone:787-292-2050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR006838183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist