Provider Demographics
NPI:1528603388
Name:RIVERA DAVILA, MARIANGELY (DC)
Entity Type:Individual
Prefix:
First Name:MARIANGELY
Middle Name:
Last Name:RIVERA DAVILA
Suffix:
Gender:F
Credentials:DC
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 774
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-0774
Mailing Address - Country:US
Mailing Address - Phone:787-409-2159
Mailing Address - Fax:
Practice Address - Street 1:41 CALLE DEGETAU
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-1687
Practice Address - Country:US
Practice Address - Phone:787-409-2159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-15
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12449111N00000X
PR728111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
No111N00000XChiropractic ProvidersChiropractor