Provider Demographics
NPI:1225486459
Name:RIVERA AVILES, JONATHAN (MRC)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:RIVERA AVILES
Suffix:
Gender:M
Credentials:MRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BRISAS DEL NORTE
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-9818
Mailing Address - Country:US
Mailing Address - Phone:787-477-5657
Mailing Address - Fax:
Practice Address - Street 1:4 BRISAS DEL NORTE
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-9818
Practice Address - Country:US
Practice Address - Phone:787-477-5657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1601225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor