Healthcare Provider Details

I. General information

NPI: 1376767160
Provider Name (Legal Business Name): MYRA RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CENTRO DE AYUDA ALAPAS

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 CALLE JULIAN BLANCO SANTA RITA
SAN JUAN PR
00925-2804
US

IV. Provider business mailing address

11 CALLE JULIAN BLANCO SANTA RITA
SAN JUAN PR
00925-2804
US

V. Phone/Fax

Practice location:
  • Phone: 305-479-2484
  • Fax: 304-394-6413
Mailing address:
  • Phone: 305-479-2484
  • Fax: 304-394-6413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: