Healthcare Provider Details

I. General information

NPI: 1679169957
Provider Name (Legal Business Name): DHALMA H RIVERA SOCIAL WORKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 12/21/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE LIZZIE GRAHAM HF16 AVE SABANA SECA, 7MA SECCION
TOA BAJA PR
00949
US

IV. Provider business mailing address

CALLE C DD 32 BAYAMON GARDEN
BAYAMON PR
00957
US

V. Phone/Fax

Practice location:
  • Phone: 787-795-2935
  • Fax:
Mailing address:
  • Phone: 787-604-0230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number25338
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: