Provider Demographics
NPI:1972737526
Name:RIVERA, EMIR SOTERO (PSICOLGO)
Entity Type:Individual
Prefix:MR
First Name:EMIR
Middle Name:SOTERO
Last Name:RIVERA
Suffix:
Gender:M
Credentials:PSICOLGO
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 1167
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-1167
Mailing Address - Country:US
Mailing Address - Phone:787-832-3129
Mailing Address - Fax:787-831-3714
Practice Address - Street 1:410 AVE HOSTOS SUITE 7
Practice Address - Street 2:CENTRO SALUD MENTAL DE MAYAGUEZ
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-1522
Practice Address - Country:US
Practice Address - Phone:787-831-3714
Practice Address - Fax:787-831-3714
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3293103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical