Provider Demographics
NPI:1649251927
Name:RIVERA-SANTIAGO, FRANCISCO VIDEL (PSY D)
Entity type:Individual
Prefix:
First Name:FRANCISCO
Middle Name:VIDEL
Last Name:RIVERA-SANTIAGO
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 359
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-0359
Mailing Address - Country:US
Mailing Address - Phone:787-790-9131
Mailing Address - Fax:787-273-9806
Practice Address - Street 1:20 PINEIRO ST
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-790-9131
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR991103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
87700RIOtherTRIPLE S
0087700Medicare ID - Type Unspecified