Healthcare Provider Details

I. General information

NPI: 1942129879
Provider Name (Legal Business Name): JOSEANN MANUEL RIVERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2190 PONCE BYP
PONCE PR
00716-0315
US

IV. Provider business mailing address

A12 CALLE ORQUIDEA URBANIZACION SANTA ELENA 2
GUAYANILLA PR
00656-1449
US

V. Phone/Fax

Practice location:
  • Phone: 787-844-4628
  • Fax:
Mailing address:
  • Phone: 787-677-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4611
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: