Provider Demographics
NPI:1669725289
Name:RIVERA, KARIELA
Entity type:Individual
Prefix:
First Name:KARIELA
Middle Name:
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 1:273 CALLE PERUSA
Mailing Address - Street 2:URB. COLLEGE PARK
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-4309
Mailing Address - Country:US
Mailing Address - Phone:787-529-1385
Mailing Address - Fax:
Practice Address - Street 1:273 CALLE PERUSA
Practice Address - Street 2:URB. COLLEGE PARK
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-4309
Practice Address - Country:US
Practice Address - Phone:787-529-1385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1465133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered