Provider Demographics
NPI:1013230671
Name:RIVERA, ROSA MARIA (BACHELOR DEGREE)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:MARIA
Last Name:RIVERA
Suffix:
Gender:F
Credentials:BACHELOR DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. LOS FLAMBOYANES #236 CALLE MALAGUETA
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:787-316-9290
Mailing Address - Fax:
Practice Address - Street 1:236 CALLE MALAGUETA
Practice Address - Street 2:CALLE MALAGUETA 236 LOS FLAMBOYANES
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778-2775
Practice Address - Country:US
Practice Address - Phone:787-316-9290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2010-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR556225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist