Healthcare Provider Details

I. General information

NPI: 1730011842
Provider Name (Legal Business Name): ALEXANDRA MARIE SANTIAGO RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2118 PONCE BY PASS LOCAL A SUITE A URB. INDUSTRIAL REPARADA
PONCE PR
00716-0315
US

IV. Provider business mailing address

PO BOX 294
SALINAS PR
00751-0294
US

V. Phone/Fax

Practice location:
  • Phone: 787-223-2029
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number004331
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: