Provider Demographics
NPI:1477396588
Name:RIVERA LOPEZ, DIMAYRA (PHD)
Entity type:Individual
Prefix:
First Name:DIMAYRA
Middle Name:
Last Name:RIVERA LOPEZ
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 1:3J13 CALLE 105
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-3430
Mailing Address - Country:US
Mailing Address - Phone:787-313-9818
Mailing Address - Fax:
Practice Address - Street 1:3J13 CALLE 105
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-3430
Practice Address - Country:US
Practice Address - Phone:787-313-9818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8011103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical