Provider Demographics
NPI:1619689874
Name:FRAU RIVERA, SOFIA ISABEL
Entity Type:Individual
Prefix:
First Name:SOFIA
Middle Name:ISABEL
Last Name:FRAU 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:PO BOX 105
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-0105
Mailing Address - Country:US
Mailing Address - Phone:787-218-7777
Mailing Address - Fax:
Practice Address - Street 1:URB. LA ARBOLEDA CALLE ROBLE A-8
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769
Practice Address - Country:US
Practice Address - Phone:787-218-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program