Healthcare Provider Details

I. General information

NPI: 1255961595
Provider Name (Legal Business Name): ROSANGELES DEL TORO RIVERA MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 149 KM 7.5 BO ARRIBA SALIENTE
MANATI PR
00674
US

IV. Provider business mailing address

URB LOS ANGELES 51 CALLE ORION
CAROLINA PR
00979
US

V. Phone/Fax

Practice location:
  • Phone: 787-884-5700
  • Fax:
Mailing address:
  • Phone: 787-398-1505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4100
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: