Provider Demographics
NPI:1689098477
Name:RIVERA, CORAL (PHD)
Entity Type:Individual
Prefix:
First Name:CORAL
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PHD
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 4193
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00958-1193
Mailing Address - Country:US
Mailing Address - Phone:787-637-1159
Mailing Address - Fax:787-545-4246
Practice Address - Street 1:CARR 167
Practice Address - Street 2:MARGINAL BUENA VISTA U-1
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-4477
Practice Address - Country:US
Practice Address - Phone:787-637-1159
Practice Address - Fax:787-545-4246
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2286103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical