Provider Demographics
NPI:1730656984
Name:RIVERA, JAYRIS MARIE (RDN, LND)
Entity Type:Individual
Prefix:MRS
First Name:JAYRIS
Middle Name:MARIE
Last Name:RIVERA
Suffix:
Gender:F
Credentials:RDN, LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. OLYMPIC VILLE CALLE TOKIO M-8
Mailing Address - Street 2:55
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-9686
Mailing Address - Country:US
Mailing Address - Phone:787-221-1436
Mailing Address - Fax:
Practice Address - Street 1:URB. OLYMPIC VILLE CALLE TOKIO M-8
Practice Address - Street 2:55
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771-9686
Practice Address - Country:US
Practice Address - Phone:787-221-1436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2052133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist