Provider Demographics
NPI:1073234407
Name:RIVERA RIVERA, MARIECARMEN (DC)
Entity Type:Individual
Prefix:
First Name:MARIECARMEN
Middle Name:
Last Name:RIVERA RIVERA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 COND VISTAMAR PRINCESS APT 107
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983-1469
Mailing Address - Country:US
Mailing Address - Phone:787-509-6902
Mailing Address - Fax:
Practice Address - Street 1:1 COND VISTAMAR PRINCESS APT 107
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983-1469
Practice Address - Country:US
Practice Address - Phone:787-509-6902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-05
Last Update Date:2022-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR881111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor