Healthcare Provider Details

I. General information

NPI: 1285228437
Provider Name (Legal Business Name): MS. ENEIDA RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-29 CALLE 90A # 29
CAROLINA PR
00985-4137
US

IV. Provider business mailing address

91-29 CALLE 90A # 29
CAROLINA PR
00985-4137
US

V. Phone/Fax

Practice location:
  • Phone: 939-256-7309
  • Fax:
Mailing address:
  • Phone: 939-256-7309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6275
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: