Provider Demographics
NPI:1609204452
Name:RIVERA, LIDIETTE
Entity Type:Individual
Prefix:
First Name:LIDIETTE
Middle Name:
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:P.O.BOX 686
Mailing Address - Street 2:
Mailing Address - City:VIEQUES
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00765
Mailing Address - Country:UM
Mailing Address - Phone:787-741-0922
Mailing Address - Fax:
Practice Address - Street 1:BO. LEGUILLOW, CALLE APOLONIA GITTINGS
Practice Address - Street 2:E-14
Practice Address - City:VIEQUES
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00765
Practice Address - Country:UM
Practice Address - Phone:787-741-0922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-14
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program