Individual
LADY RIVERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7-1 BO PALENQUE 1A, BARCELONETA, PR 00617
(413) 275-9406
Mailing address
7-1 BO PALENQUE 1A, BARCELONETA, PR 00617
(413) 275-9406
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
4764057
PR
343800000X
Secured Medical Transport (VAN)
4764057
PR
343900000X
Non-emergency Medical Transport (VAN)
4764057
PR
347C00000X
Private Vehicle
Primary
4764057
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1001442-0010
SURI - HACIENDA
PR
Enumeration date
12/12/2016
Last updated
12/14/2016
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