Provider Demographics
NPI:1922190362
Name:RIVERA VELEZ, ADA
Entity Type:Individual
Prefix:
First Name:ADA
Middle Name:
Last Name:RIVERA VELEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ADA
Other - Middle Name:
Other - Last Name:RIVERA VELEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:CALLE MERCED D-25
Mailing Address - Street 2:COLINAS DEL MARQUEZ
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:787-455-1615
Mailing Address - Fax:787-870-6537
Practice Address - Street 1:CALLE EG-22
Practice Address - Street 2:URB BRAZILIA OF#3
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-455-1615
Practice Address - Fax:787-870-6537
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR74491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0023261Medicare ID - Type UnspecifiedMEDICARE