Provider Demographics
NPI:1205118023
Name:RIVERA, REINILDA (MPH)
Entity type:Individual
Prefix:
First Name:REINILDA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. PARK GARDENS Y-20 CALLE YELLOWSTONE
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-2221
Mailing Address - Country:US
Mailing Address - Phone:787-399-7375
Mailing Address - Fax:
Practice Address - Street 1:URB. PARK GARDENS Y-20 CALLE YELLOWSTONE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-2221
Practice Address - Country:US
Practice Address - Phone:787-399-7375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2024-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1566133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist