Provider Demographics
NPI:1740520170
Name:RIVERA, ANGEL MANUEL (DC)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:MANUEL
Last Name:RIVERA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 CALLE UCAR
Mailing Address - Street 2:LOS CAMINOS
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754-9972
Mailing Address - Country:US
Mailing Address - Phone:787-676-4473
Mailing Address - Fax:
Practice Address - Street 1:85 CALLE UCAR
Practice Address - Street 2:LOS CAMINOS
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754-9972
Practice Address - Country:US
Practice Address - Phone:787-676-4473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR550111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor