Provider Demographics
NPI:1316008451
Name:RIVERA NIEVES, LILLIANA (THERAPIST)
Entity Type:Individual
Prefix:
First Name:LILLIANA
Middle Name:
Last Name:RIVERA NIEVES
Suffix:
Gender:F
Credentials:THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BARRIO BRENAS, STREET 693,
Mailing Address - Street 2:NO. 271
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692
Mailing Address - Country:US
Mailing Address - Phone:787-883-3939
Mailing Address - Fax:787-270-4933
Practice Address - Street 1:BARRIO BRENAS, STREET 693
Practice Address - Street 2:NO. 271
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-883-3939
Practice Address - Fax:787-270-4399
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1046208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6920027OtherHUMANA HEALTH PLAN
PRP715OtherINTERNATIONAL MEDICAL CAR
PR82011OtherBLUE CROSS BLUE SHIELD
PRP715OtherINTERNATIONAL MEDICAL CAR