MEDICARE: PROF. NAYCHALY RIVERA NIEVES M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	3936	PR

General Provider Information

NPI Number	:	1194021899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. NAYCHALY RIVERA NIEVES M.A.

Provider Business Mailing Address
First Line	:	410 CALLE DE DIEGO
Second Line	:	WINDSOR TOWER 711
City	:	SAN JUAN
State	:	PR
Zip	:	00923-3000
Country	:	US
Telephone Number	:	787-509-1665
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 CALLE DE DIEGO
Second Line	:	WINDSOR TOWER 711
City	:	SAN JUAN
State	:	PR
Zip	:	00923-3000
Country	:	US
Telephone Number	:	787-509-1665
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2011
Last Update Date	:	01/28/2011

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