Provider Demographics
NPI:1356932818
Name:SEPULVEDA RIVERA, CORALYS MILAGROS (RDN)
Entity type:Individual
Prefix:MISS
First Name:CORALYS
Middle Name:MILAGROS
Last Name:SEPULVEDA RIVERA
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 5 BOX 5897
Mailing Address - Street 2:
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767-9699
Mailing Address - Country:US
Mailing Address - Phone:787-238-7126
Mailing Address - Fax:
Practice Address - Street 1:URB. PEREYO #9 CALLE ORION
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-998-2040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR86054765133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty