Provider Demographics
NPI:1043407265
Name:RIVERA, BRENDA LUZ
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LUZ
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 CALLE MARIA MOCZO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00911-2212
Mailing Address - Country:US
Mailing Address - Phone:787-635-8721
Mailing Address - Fax:
Practice Address - Street 1:165 CALLE MARIA MOCZO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00911-2212
Practice Address - Country:US
Practice Address - Phone:787-635-8721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1458-12355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant