Provider Demographics
NPI:1174050975
Name:RIVAS, PABLO
Entity type:Individual
Prefix:
First Name:PABLO
Middle Name:
Last Name:RIVAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 CALLE ISRAELI
Mailing Address - Street 2:URB. BRISAS DE METROPOLITAS
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-7729
Mailing Address - Country:US
Mailing Address - Phone:787-582-1442
Mailing Address - Fax:
Practice Address - Street 1:14 CALLE ISRAEIL
Practice Address - Street 2:URB. BRISAS DE METROPOLIS
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-528-1442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician