Provider Demographics
NPI:1336785823
Name:RIVERA, CARLOS JAIME
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:JAIME
Last Name:RIVERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 AVE FELIX RIOS
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-3539
Mailing Address - Country:US
Mailing Address - Phone:787-696-5363
Mailing Address - Fax:
Practice Address - Street 1:297 AVE FELIX RIOS
Practice Address - Street 2:
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-3539
Practice Address - Country:US
Practice Address - Phone:787-696-5363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-20
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224Z00000X
PR1073224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant