Provider Demographics
NPI:1740509470
Name:RIVERA NEGRON, NISHA L (LCDA)
Entity type:Individual
Prefix:
First Name:NISHA
Middle Name:L
Last Name:RIVERA NEGRON
Suffix:
Gender:F
Credentials:LCDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11182 MARGARITA STREET URB. HACIENDA CONCORDIA
Mailing Address - Street 2:
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757
Mailing Address - Country:US
Mailing Address - Phone:787-209-4146
Mailing Address - Fax:
Practice Address - Street 1:20 CALLE RUFINA
Practice Address - Street 2:SUITE 2 BAJOS
Practice Address - City:GUAYANILLA
Practice Address - State:PR
Practice Address - Zip Code:00656
Practice Address - Country:US
Practice Address - Phone:787-209-4146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1528133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist