Provider Demographics
NPI:1073930327
Name:PEREZ RIVERA, MIGDALIA
Entity Type:Individual
Prefix:
First Name:MIGDALIA
Middle Name:
Last Name:PEREZ 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:CALLE CUEVILLA 559
Mailing Address - Street 2:APT. 4-A
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-0000
Mailing Address - Country:US
Mailing Address - Phone:787-249-3315
Mailing Address - Fax:787-200-6734
Practice Address - Street 1:CALLE CUEVILLA 559
Practice Address - Street 2:APT. 4-A
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-0000
Practice Address - Country:US
Practice Address - Phone:787-249-3315
Practice Address - Fax:787-200-6734
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR556103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist