Provider Demographics
NPI:1558078014
Name:RIVERA SOTO, WILMARIS (LCDA)
Entity Type:Individual
Prefix:
First Name:WILMARIS
Middle Name:
Last Name:RIVERA SOTO
Suffix:
Gender:F
Credentials:LCDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. BRISAS DE AIBONITO
Mailing Address - Street 2:TRINITARIA 48
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705
Mailing Address - Country:US
Mailing Address - Phone:787-358-2208
Mailing Address - Fax:
Practice Address - Street 1:URB. BRISAS DE AIBONITO
Practice Address - Street 2:TRINITARIA 48
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705
Practice Address - Country:US
Practice Address - Phone:787-358-2208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4224235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist