MEDICARE: JEILEEN RUIZ RIVERA PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	8892	PR

General Provider Information

NPI Number	:	1144171919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEILEEN RUIZ RIVERA PSYD

Provider Business Mailing Address
First Line	:	URB LOS CAOBOS CALLE GUAMA 1869
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00716
Country	:	US
Telephone Number	:	787-373-2518
Fax Number	:

Provider Business Practice Location Address
First Line	:	2213 PONCE BYPASS, PONCE
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00717
Country	:	US
Telephone Number	:	787-840-8686
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2026
Last Update Date	:	02/06/2026

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