Provider Demographics
NPI:1710198387
Name:RIVERA, GLADYS (OT)
Entity Type:Individual
Prefix:MRS
First Name:GLADYS
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 CALLE LUQUILLO
Mailing Address - Street 2:VILLAS DE LA PLAYA
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693-6057
Mailing Address - Country:US
Mailing Address - Phone:787-346-3676
Mailing Address - Fax:
Practice Address - Street 1:370 CALLE LUQUILLO
Practice Address - Street 2:VILLAS DE LA PLAYA
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-6057
Practice Address - Country:US
Practice Address - Phone:787-346-3676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR197174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist