Healthcare Provider Details

I. General information

NPI: 1164209540
Provider Name (Legal Business Name): CHRISTOPHER PRIETO RIVERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 04/12/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HF16 CALLE LIZZIE GRAHAM
TOA BAJA PR
00949-3634
US

IV. Provider business mailing address

HF16 CALLE LIZZIE GRAHAM
TOA BAJA PR
00949-3634
US

V. Phone/Fax

Practice location:
  • Phone: 787-795-2935
  • Fax:
Mailing address:
  • Phone: 787-679-6129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number005851
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: