Healthcare Provider Details

I. General information

NPI: 1851783906
Provider Name (Legal Business Name): MRS. NELLY RIVERA I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2015
Last Update Date: 02/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO.MARICAO APARTADO 5165
VEGA ALTA PUERTO RICO
00692
UM

IV. Provider business mailing address

APARTADO 5165 BO.MARIACO
VEGA ALTA PR
00692-0000
US

V. Phone/Fax

Practice location:
  • Phone: 787-908-3004
  • Fax:
Mailing address:
  • Phone: 787-908-3004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: