Provider Demographics
NPI:1073935920
Name:RIVERA, ZELIDETH (RN)
Entity Type:Individual
Prefix:MRS
First Name:ZELIDETH
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STREET 2 G 8
Mailing Address - Street 2:URB.PARQUE SAN MIGUEL
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:STREET 2 G 8
Practice Address - Street 2:URB.PARQUE SAN MIGUEL
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-4209
Practice Address - Country:US
Practice Address - Phone:787-949-7096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19115163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse