Provider Demographics
NPI:1851783906
Name:RIVERA, NELLY I
Entity Type:Individual
Prefix:MRS
First Name:NELLY
Middle Name:
Last Name:RIVERA
Suffix:I
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:APARTADO 5165
Mailing Address - Street 2:BO.MARIACO
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-0000
Mailing Address - Country:US
Mailing Address - Phone:787-908-3004
Mailing Address - Fax:
Practice Address - Street 1:BO.MARICAO
Practice Address - Street 2:APARTADO 5165
Practice Address - City:VEGA ALTA
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00692
Practice Address - Country:UM
Practice Address - Phone:787-908-3004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No172A00000XOther Service ProvidersDriver