Healthcare Provider Details

I. General information

NPI: 1881328912
Provider Name (Legal Business Name): JAVIER POLA-RIVERA CNS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

C17 CALLE MARGINAL
BAYAMON PR
00961-6706
US

IV. Provider business mailing address

URB. CASAMIA 4713 CALLE PITIRRE
PONCE PR
00728-3418
US

V. Phone/Fax

Practice location:
  • Phone: 787-780-1273
  • Fax: 787-786-8690
Mailing address:
  • Phone: 939-500-1364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number73442G
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number2955
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: