Provider Demographics
NPI:1033630108
Name:RIVERA-VALLES, JEANNETTE MARIE (MSPECED)
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:MARIE
Last Name:RIVERA-VALLES
Suffix:
Gender:F
Credentials:MSPECED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10537 64TH AVE APT 1C
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1646
Mailing Address - Country:US
Mailing Address - Phone:917-548-6269
Mailing Address - Fax:
Practice Address - Street 1:10537 64TH AVE APT 1C
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1646
Practice Address - Country:US
Practice Address - Phone:917-548-6269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist