Provider Demographics
NPI:1336623768
Name:FEBLES RIVERA, CLARITZA (LND)
Entity Type:Individual
Prefix:
First Name:CLARITZA
Middle Name:
Last Name:FEBLES RIVERA
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB ESTANCIAS DE MANATI
Mailing Address - Street 2:147 CALLE DORADO
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-904-3899
Mailing Address - Fax:787-854-3701
Practice Address - Street 1:URB ESTANCIAS DE MANATI
Practice Address - Street 2:147 CALLE DORADO
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-904-3899
Practice Address - Fax:787-854-3701
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1580133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty