Provider Demographics
NPI:1205065075
Name:PINERO RIVERA, IVELISSE (MS,SLP,CCPLSVT,BOM)
Entity type:Individual
Prefix:
First Name:IVELISSE
Middle Name:
Last Name:PINERO RIVERA
Suffix:
Gender:F
Credentials:MS,SLP,CCPLSVT,BOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. CASA BELLA
Mailing Address - Street 2:35 CALLE NAPOLES
Mailing Address - City:NAGUABO
Mailing Address - State:PR
Mailing Address - Zip Code:00718-2826
Mailing Address - Country:US
Mailing Address - Phone:787-692-2422
Mailing Address - Fax:
Practice Address - Street 1:BARALT CALLE MARGINAL
Practice Address - Street 2:A-49
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-692-2422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR908235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist