Provider Demographics
NPI:1255574968
Name:LOPEZ-RIVERA, GERALDINNE NAHIR (PHD)
Entity type:Individual
Prefix:DR
First Name:GERALDINNE
Middle Name:NAHIR
Last Name:LOPEZ-RIVERA
Suffix:
Gender:F
Credentials:PHD
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 6400 PMB 180
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737
Mailing Address - Country:US
Mailing Address - Phone:303-731-2191
Mailing Address - Fax:
Practice Address - Street 1:FRACCLONAMIENTO TUMBEN CHILAM CALLE CHAC
Practice Address - Street 2:MANZANA 29 LOTE 18
Practice Address - City:PLAYA DEL CARMEN
Practice Address - State:QUINTANA ROO
Practice Address - Zip Code:77725
Practice Address - Country:MX
Practice Address - Phone:303-731-2191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-10
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3254103TS0200X
SC251631103TS0200X
CO96639103TS0200X
ZZ10443613103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool