Healthcare Provider Details

I. General information

NPI: 1154116598
Provider Name (Legal Business Name): CRYSTAL MARIE RIVERA PEREZ ATO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/14/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 AVE AVELINO VICENTE
SAN JUAN PR
00909-2538
US

IV. Provider business mailing address

1050 AV. LAS PALMAS COND. PUERTA DE LA BAHIA APT. #912
SAN JUAN PR
00907
US

V. Phone/Fax

Practice location:
  • Phone: 787-303-9662
  • Fax:
Mailing address:
  • Phone: 787-202-3457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number2703-1
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: