Provider Demographics
NPI:1255488961
Name:RIVAS-ABRAHAM, JOSE (PSYD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:RIVAS-ABRAHAM
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE AZUCENA 1
Mailing Address - Street 2:URB. RIO PIEDRAS VALLEY
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-1426
Mailing Address - Country:US
Mailing Address - Phone:787-728-3800
Mailing Address - Fax:787-728-3850
Practice Address - Street 1:SAN JORGE MEDICAL BUILDING 258
Practice Address - Street 2:SUITE 204,
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00912
Practice Address - Country:US
Practice Address - Phone:787-728-3800
Practice Address - Fax:787-728-3850
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1484103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical