Provider Demographics
NPI:1760847131
Name:ROLON RIVERA, MADIELIZ (MS)
Entity Type:Individual
Prefix:
First Name:MADIELIZ
Middle Name:
Last Name:ROLON RIVERA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB EST DEL BOSQUE 899 CALLE ROBLES
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-8413
Mailing Address - Country:US
Mailing Address - Phone:787-203-7895
Mailing Address - Fax:
Practice Address - Street 1:CARR 734 KM. 0.5
Practice Address - Street 2:BARRIO ARENAS
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739-0000
Practice Address - Country:US
Practice Address - Phone:787-203-7895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-29
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR003064235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist