Provider Demographics
NPI:1477101871
Name:RIVERA, ADA I (RDA)
Entity Type:Individual
Prefix:MRS
First Name:ADA
Middle Name:I
Last Name:RIVERA
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2473
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-2473
Mailing Address - Country:US
Mailing Address - Phone:787-734-0330
Mailing Address - Fax:
Practice Address - Street 1:17 CALLE DANIEL FLORES
Practice Address - Street 2:
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777-3410
Practice Address - Country:US
Practice Address - Phone:787-734-0330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3044126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant