Provider Demographics
NPI:1750824876
Name:RIVERA, KRISTINA (MS, LND, RD)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MS, LND, RD
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 70344
Mailing Address - Street 2:PMB 128
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8344
Mailing Address - Country:US
Mailing Address - Phone:787-480-2762
Mailing Address - Fax:
Practice Address - Street 1:CENTRO MEDICO- HOSP MUNICIPAL SAN JUAN 4TO PISO
Practice Address - Street 2:BARRIO MONACILLOS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936-8344
Practice Address - Country:US
Practice Address - Phone:787-480-2762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1979133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education