Provider Demographics
NPI:1669680591
Name:RIVERA, DEBORAH (LND)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ALTS. PARQUE 212 BLVD. MEDIA LUNA
Mailing Address - Street 2:APT. 2901
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987
Mailing Address - Country:US
Mailing Address - Phone:787-317-8317
Mailing Address - Fax:
Practice Address - Street 1:ALTS. PARQUE 212 BLVD. MEDIA LUNA
Practice Address - Street 2:APT. 2901
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-317-8317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1278133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered