Provider Demographics
NPI:1508575150
Name:RIVERA, AXEL MANUEL (MS)
Entity Type:Individual
Prefix:
First Name:AXEL
Middle Name:MANUEL
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 CALLE SAN JUAN N
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-2560
Mailing Address - Country:US
Mailing Address - Phone:787-610-7977
Mailing Address - Fax:
Practice Address - Street 1:CARR. PR #64 ESQ. CALLE 3
Practice Address - Street 2:URB. INDUSTRIAL
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-838-7272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist