Healthcare Provider Details

I. General information

NPI: 1043130479
Provider Name (Legal Business Name): LIZ NELLY RIVERA MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PR #2 KM 159.0 AVENIDA HOSTOS 826 EDIFICIO VILLA CAPITAN III SUITE 101
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

B4 CALLE 5
CABO ROJO PR
00623-4702
US

V. Phone/Fax

Practice location:
  • Phone: 939-499-5888
  • Fax:
Mailing address:
  • Phone: 787-349-9159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number8257
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: