Provider Demographics
NPI:1760424923
Name:LEBRON RIVERA, NELIDA
Entity Type:Individual
Prefix:
First Name:NELIDA
Middle Name:
Last Name:LEBRON 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:CALLE A I-31
Mailing Address - Street 2:REPARTO MONTELLANO
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-4112
Mailing Address - Country:US
Mailing Address - Phone:787-738-2010
Mailing Address - Fax:
Practice Address - Street 1:CALLE A I-31
Practice Address - Street 2:REPARTO MONTELLANO
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-4112
Practice Address - Country:US
Practice Address - Phone:787-738-2010
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR246Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRTP-206OtherTRIPLE-S ELECT. BILLING N
PR5000000043Medicare ID - Type UnspecifiedEMC BILLING NUMBER