Healthcare Provider Details

I. General information

NPI: 1801320882
Provider Name (Legal Business Name): LYNETTE RIVERA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2017
Last Update Date: 04/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 CALLE MINA URB MONTE ALTO
GURABO PR
00778
US

IV. Provider business mailing address

231 CALLE LA MINA URB MONTE ALTO
GURABO PR
00778
US

V. Phone/Fax

Practice location:
  • Phone: 787-366-8118
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number1144
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: