Provider Demographics
NPI:1134844012
Name:RIVERA, CHRISTIAN JOEL
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:JOEL
Last Name:RIVERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. EXT. JARDINES DEL CARIBE 4352 CALLE 58
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728
Mailing Address - Country:US
Mailing Address - Phone:787-614-6070
Mailing Address - Fax:
Practice Address - Street 1:URB. EXT. JARDINES DEL CARIBE 4353 CALLE 58
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728
Practice Address - Country:US
Practice Address - Phone:787-614-6070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR83927163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse