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General NPI Number Information
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NPI Number | 1548734742
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Entity Type | Individual
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Provider Name | NICOLE MARIE RIVERA TORRES RDN, LND
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Gender | Female
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Dates
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Enumeration Date | 01/22/2019
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Last Update Date | 07/08/2020
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Provider Practice Location Address
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Address Line | 715 AVENIDA PONCE DE LEON NUTRITION DEPT
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City | HATO REY
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State | PR
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Zip | 00909-1958
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Country | US
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Telephone | 787-758-2000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 191227
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City | SAN JUAN
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State | PR
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Zip | 00919-1227
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 86069514
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 2077
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License Number State | PR
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