Healthcare Provider Details

I. General information

NPI: 1609256247
Provider Name (Legal Business Name): MILDRED COLTON-RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MILDRED COLTON-RIVERA CPL

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 06/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75-42 AVE RAMON LUIS RIVERA
BAYAMON PR
00960
US

IV. Provider business mailing address

PO BOX 1913
BAYAMON PR
00960-1913
US

V. Phone/Fax

Practice location:
  • Phone: 787-585-2102
  • Fax:
Mailing address:
  • Phone: 787-585-2102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2218
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: