Provider Demographics
NPI:1942335021
Name:RUBEN RIVERA MELENDEZ
Entity type:Organization
Organization Name:RUBEN RIVERA MELENDEZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA MELENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-798-3735
Mailing Address - Street 1:EDIFICIO TOMAS QUILAN
Mailing Address - Street 2:CALLE PARQUE # 32 SUITE 36
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-6110
Mailing Address - Country:US
Mailing Address - Phone:787-798-3735
Mailing Address - Fax:787-798-3735
Practice Address - Street 1:32 CALLE PARQUE STE 36
Practice Address - Street 2:EDIF. TOMAS QUILAN
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6110
Practice Address - Country:US
Practice Address - Phone:787-798-3735
Practice Address - Fax:787-798-3735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR134156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0761650001Medicare ID - Type Unspecified