Provider Demographics
NPI:1336665389
Name:RIVERA, CARLA LUISETTE (MS)
Entity Type:Individual
Prefix:MISS
First Name:CARLA
Middle Name:LUISETTE
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 URB CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-9355
Mailing Address - Country:US
Mailing Address - Phone:787-478-6447
Mailing Address - Fax:
Practice Address - Street 1:4845 SW 57TH DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-3857
Practice Address - Country:US
Practice Address - Phone:787-478-6447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-21
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004184-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist