Provider Demographics
NPI:1497025332
Name:RIVAS, VIRGINIA ISA (MHSN, LND)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:ISA
Last Name:RIVAS
Suffix:
Gender:F
Credentials:MHSN, LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BARRIO MAMEY CARRETERA 4417 RAMAL 4418 KM. 0.1
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-0000
Mailing Address - Country:US
Mailing Address - Phone:787-319-2152
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 112 KM. 3.3
Practice Address - Street 2:7468 A
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662
Practice Address - Country:US
Practice Address - Phone:787-319-2152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1650133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered