=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750842316
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HECTOR LUIS RIVERA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2019
-----------------------------------------------------
Last Update Date | 03/27/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CALLE SARGENTO GERARDO SANTIAGO CARR 14 INT 15
-----------------------------------------------------
City | AIBONITO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-714-2462
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 609
-----------------------------------------------------
City | CIDRA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00739-0609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-940-6309
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 23664
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------