Healthcare Provider Details

I. General information

NPI: 1972710069
Provider Name (Legal Business Name): JOSE M. RIVERABERG PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 CALLE SERENATA PALACIOS DE MARBELLA
TOA ALTA PR
00953-5210
US

IV. Provider business mailing address

1033 CALLE SERENATA PALACIOS DE MARBELLA
TOA ALTA PR
00953-5210
US

V. Phone/Fax

Practice location:
  • Phone: 787-786-3620
  • Fax:
Mailing address:
  • Phone: 787-786-3620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number00994
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: