Provider Demographics
NPI:1518665181
Name:PADILLA RIVERA, ANGELICA IVETTE
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:IVETTE
Last Name:PADILLA RIVERA
Suffix:
Gender:F
Credentials:
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 1880
Mailing Address - Street 2:
Mailing Address - City:BOQUERON
Mailing Address - State:PR
Mailing Address - Zip Code:00622-1880
Mailing Address - Country:US
Mailing Address - Phone:939-278-1046
Mailing Address - Fax:
Practice Address - Street 1:TORRE SAN PABLO
Practice Address - Street 2:CALLE SANTA CRUZ #68, OFICINA 606
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-909-5359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7587103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical