Provider Demographics
NPI:1073099206
Name:RIVERA-MEDINA, CHRISTIAN (RD, LND)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:RIVERA-MEDINA
Suffix:
Gender:M
Credentials:RD, LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 CALLE MUCARO
Mailing Address - Street 2:URB MIRAMELINDA ESTATE
Mailing Address - City:RIO GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00745
Mailing Address - Country:US
Mailing Address - Phone:787-549-5673
Mailing Address - Fax:
Practice Address - Street 1:83 CALLE GUAMANI
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-4319
Practice Address - Country:US
Practice Address - Phone:787-549-5673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR948612133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered