Provider Demographics
NPI:1922884964
Name:RIVERA, CATHERINE
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name: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 1:529 CALLE PADRE DELGADO
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-5823
Mailing Address - Country:US
Mailing Address - Phone:787-391-8468
Mailing Address - Fax:
Practice Address - Street 1:MCS PLAZA HATO REY SERVICE CENTER MCS
Practice Address - Street 2:FIRST FLOOR SUITE 105 AVE. PONCE DE LEON
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00916-1919
Practice Address - Country:US
Practice Address - Phone:787-281-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR883133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist