Healthcare Provider Details

I. General information

NPI: 1174315659
Provider Name (Legal Business Name): LIVIA J. RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 05/20/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 AVE. FERNANDO L. GARCIA
UTUADO PR
00641
US

IV. Provider business mailing address

PO BOX 522
UTUADO PR
00641-0522
US

V. Phone/Fax

Practice location:
  • Phone: 787-391-2772
  • Fax:
Mailing address:
  • Phone: 787-391-2772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355A2700X
TaxonomyAudiology Assistant
License Number249
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: