Healthcare Provider Details

I. General information

NPI: 1477486124
Provider Name (Legal Business Name): MIRNA RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 CALLE LORENCITA FERRER PARCELAS EL TUQUE
PONCE PR
00728
US

IV. Provider business mailing address

4940 CALLE LORENCITA FERRER PARCELAS EL TUQUE
PONCE PR
00728
US

V. Phone/Fax

Practice location:
  • Phone: 939-732-2625
  • Fax:
Mailing address:
  • Phone: 939-732-2625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number1153
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: