Provider Demographics
NPI:1114384351
Name:RIVERA ZAMBRANA, WILMER (SOCIAL WORKER)
Entity Type:Individual
Prefix:MR
First Name:WILMER
Middle Name:
Last Name:RIVERA ZAMBRANA
Suffix:
Gender:M
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 3 BOX 18133
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-9822
Mailing Address - Country:US
Mailing Address - Phone:787-296-9777
Mailing Address - Fax:787-296-9712
Practice Address - Street 1:HC 3 BOX 18133
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769-9822
Practice Address - Country:US
Practice Address - Phone:787-296-9777
Practice Address - Fax:787-296-9777
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR107121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical