Provider Demographics
NPI:1356482301
Name:HERNANDEZ RIVERA, NYDIA IRIS (PSIC IT-O)
Entity Type:Individual
Prefix:MS
First Name:NYDIA
Middle Name:IRIS
Last Name:HERNANDEZ RIVERA
Suffix:
Gender:F
Credentials:PSIC IT-O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC-01 BOX 7066
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-9617
Mailing Address - Country:US
Mailing Address - Phone:787-364-4605
Mailing Address - Fax:787-877-3696
Practice Address - Street 1:205 CALLE JUAN SAN ANTONIO
Practice Address - Street 2:EDIFICIO BPOSQUES
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-9617
Practice Address - Country:US
Practice Address - Phone:787-364-4605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-11
Last Update Date:2019-07-12
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2010-06-03
Provider Licenses
StateLicense IDTaxonomies
PR795225X00000X
PR3567103T00000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist