Healthcare Provider Details

I. General information

NPI: 1255809034
Provider Name (Legal Business Name): YESAIRA RIVERA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2018
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. PARQUE LAS FLORES 207 CALLE FLOR DE LOTO
COAMO PR
00769
US

IV. Provider business mailing address

URB. PARQUE LAS FLORES 207 CALLE FLOR DE LOTO
COAMO PR
00769
US

V. Phone/Fax

Practice location:
  • Phone: 787-629-7372
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number9158
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: