Provider Demographics
NPI:1255672770
Name:RIVERA, DALIBETH (LND)
Entity Type:Individual
Prefix:
First Name:DALIBETH
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:PR
Mailing Address - Zip Code:00677-0432
Mailing Address - Country:US
Mailing Address - Phone:787-605-6211
Mailing Address - Fax:
Practice Address - Street 1:UR. COLINAS DE MONTEMAR
Practice Address - Street 2:A-4
Practice Address - City:RINCON
Practice Address - State:PR
Practice Address - Zip Code:00677
Practice Address - Country:US
Practice Address - Phone:787-605-6211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1419133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist