Provider Demographics
NPI:1295496263
Name:RIVERA, DYLAILA
Entity type:Individual
Prefix:
First Name:DYLAILA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 223
Mailing Address - Street 2:LA PLATA
Mailing Address - City:AIBOITO
Mailing Address - State:PR
Mailing Address - Zip Code:00786
Mailing Address - Country:US
Mailing Address - Phone:787-613-0669
Mailing Address - Fax:
Practice Address - Street 1:CARR. 173 KM 1
Practice Address - Street 2:LA PLATA
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00786
Practice Address - Country:US
Practice Address - Phone:787-613-0669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004285235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty