Healthcare Provider Details

I. General information

NPI: 1124041777
Provider Name (Legal Business Name): ANGELES RIVERA-GUTIERREZ OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGIE RIVERA-GUTIERREZ OTR/L

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CALLE CASIA
SAN JUAN PR
00921-3200
US

IV. Provider business mailing address

AQ2 CALLE 36 JARDINES DE COUNTRY CLUB
CAROLINA PR
00983-1605
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-7582
  • Fax:
Mailing address:
  • Phone: 787-269-6359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1300X
TaxonomyHuman Factors Occupational Therapist
License Number219
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: