Healthcare Provider Details

I. General information

NPI: 1952633901
Provider Name (Legal Business Name): RAYMOND RIVERA PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 RAMON RIOS AVENUE SUITE 23
TOA BAJA PR
00950
US

IV. Provider business mailing address

PO BOX 783 SABANA SECA
TOA BAJA PR
00951-0783
US

V. Phone/Fax

Practice location:
  • Phone: 787-910-2567
  • Fax:
Mailing address:
  • Phone: 787-910-2567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3649
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: