Provider Demographics
NPI:1659000479
Name:RIVERA ROLON, SHIRLEY A
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:A
Last Name:RIVERA ROLON
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:URB. LOS CAOBOS
Mailing Address - Street 2:CALLE GUAYNABO 1805
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716
Mailing Address - Country:US
Mailing Address - Phone:787-202-1650
Mailing Address - Fax:
Practice Address - Street 1:URB. TROPICAL GARDENS CARR 360 KM 1.4
Practice Address - Street 2:EDF. PROFESIONAL 3R
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-892-2771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00413235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist