Healthcare Provider Details

I. General information

NPI: 1861500779
Provider Name (Legal Business Name): NINNA S RIVERA CORREA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE GARCIA DE LA NOCEDA B18 VILLAS DE RIO GRANDE
RIO GRANDE PR
00745
US

IV. Provider business mailing address

B18 CALLE GARCIA DE LA NOC
RIO GRANDE PR
00745-2816
US

V. Phone/Fax

Practice location:
  • Phone: 787-887-2555
  • Fax:
Mailing address:
  • Phone: 787-887-2555
  • Fax: 787-657-5600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number3227
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: