Provider Demographics
NPI:1548734742
Name:RIVERA TORRES, NICOLE MARIE (RDN, LND)
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:MARIE
Last Name:RIVERA TORRES
Suffix:
Gender:F
Credentials:RDN, LND
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 191227
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-1227
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:715 AVENIDA PONCE DE LEON
Practice Address - Street 2:NUTRITION DEPT
Practice Address - City:HATO REY
Practice Address - State:PR
Practice Address - Zip Code:00909-1958
Practice Address - Country:US
Practice Address - Phone:787-758-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR86069514133V00000X
PR2077133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR86069514OtherREGISTERED DIETITAN NUTRITIONIST
PR2077OtherDIETITIAN'S LICENCE