Provider Demographics
NPI:1417167081
Name:RIVERA NIEVES, ROSSIE L (OD)
Entity Type:Individual
Prefix:DR
First Name:ROSSIE
Middle Name:L
Last Name:RIVERA NIEVES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LOS COLOBOS SHOPPING CENTER
Mailing Address - Street 2:SUITE 15555
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987
Mailing Address - Country:US
Mailing Address - Phone:787-717-7144
Mailing Address - Fax:
Practice Address - Street 1:LOS COLOBOS SHOPPING CENTER
Practice Address - Street 2:SUITE 15555
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-717-7144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2013-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6390157152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist