Provider Demographics
NPI:1770355836
Name:RIVERA SOLIS, EDDIE MANUEL (MSW)
Entity type:Individual
Prefix:MR
First Name:EDDIE
Middle Name:MANUEL
Last Name:RIVERA SOLIS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 67820
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-9818
Mailing Address - Country:US
Mailing Address - Phone:787-559-6350
Mailing Address - Fax:
Practice Address - Street 1:CARR 921 KM 0.5 BARRIO LA SABANA
Practice Address - Street 2:CALLE JUAN DE DIOS
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771
Practice Address - Country:US
Practice Address - Phone:787-550-6350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11496104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker