Provider Demographics
NPI:1225523111
Name:VIVES RODRIGUEZ, GLORISEL
Entity Type:Individual
Prefix:
First Name:GLORISEL
Middle Name:
Last Name:VIVES RODRIGUEZ
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 1:7358 CARR 485
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-9706
Mailing Address - Country:US
Mailing Address - Phone:787-356-0837
Mailing Address - Fax:
Practice Address - Street 1:BO HATO ABAJO SECTOR BARRANCA
Practice Address - Street 2:CARR 653 KM 2.5
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-563-0124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR559224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant