Provider Demographics
NPI:1821849217
Name:NATAL RIVERA, WILMALISSE (DC)
Entity Type:Individual
Prefix:
First Name:WILMALISSE
Middle Name:
Last Name:NATAL RIVERA
Suffix:
Gender:F
Credentials:DC
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 368
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:PR
Mailing Address - Zip Code:00751-0368
Mailing Address - Country:US
Mailing Address - Phone:787-632-8484
Mailing Address - Fax:
Practice Address - Street 1:220 WESTERN AUTO PLAZA
Practice Address - Street 2:STE 203
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-292-0905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR981111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor