Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 3283 | PR |
NPI | 1154808228 |
---|---|
Provider Name | Dr. Victor Antonio Rivera Mendez |
First Address | San Juan, PR 00918-4173 |
Second Address | Bayamon, PR 00961 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2018 |
Last Update Date | 23/07/2018 |