Provider Demographics
NPI:1437441755
Name:RIVERA, ADA MARIE (LND)
Entity Type:Individual
Prefix:MRS
First Name:ADA
Middle Name:MARIE
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:OO3 CALLE LILLY
Mailing Address - Street 2:ALTURAS DE BORINQUEN GARDENS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5933
Mailing Address - Country:US
Mailing Address - Phone:787-272-1158
Mailing Address - Fax:787-272-1158
Practice Address - Street 1:OO-3 CALLE LILLY
Practice Address - Street 2:ALTURAS DE BORINQUEN GARDENS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-5933
Practice Address - Country:US
Practice Address - Phone:787-272-1158
Practice Address - Fax:787-272-1158
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR959133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist