Provider Demographics
NPI:1689064966
Name:RIVERA, IBBIS
Entity Type:Individual
Prefix:
First Name:IBBIS
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:R38 CALLE 22
Mailing Address - Street 2:TOA ALTA HEIGHTS
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953
Mailing Address - Country:US
Mailing Address - Phone:787-327-2772
Mailing Address - Fax:
Practice Address - Street 1:R38 CALLE 22
Practice Address - Street 2:TOA ALTA HEIGHTS
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-4247
Practice Address - Country:US
Practice Address - Phone:787-327-2772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1562235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist