Provider Demographics
NPI:1669293361
Name:RIVERA, DALIMAR SOPHIA
Entity type:Individual
Prefix:
First Name:DALIMAR
Middle Name:SOPHIA
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 2 BOX 7908
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:PR
Mailing Address - Zip Code:00751-9638
Mailing Address - Country:US
Mailing Address - Phone:787-649-0102
Mailing Address - Fax:
Practice Address - Street 1:HC 2 BOX 7908
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751-9638
Practice Address - Country:US
Practice Address - Phone:787-649-0102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-24
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR34820390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program