Provider Demographics
NPI:1538056650
Name:RIVERA, ILIA ENID
Entity type:Individual
Prefix:
First Name:ILIA
Middle Name:ENID
Last Name: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:V4 CALLE CALABURA
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-6815
Mailing Address - Country:US
Mailing Address - Phone:787-646-6830
Mailing Address - Fax:
Practice Address - Street 1:232 CALLE ELEONOR ROOSEVELT STE 201
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3056
Practice Address - Country:US
Practice Address - Phone:787-629-4293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8526103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling