Provider Demographics
NPI:1780274787
Name:RIVAS, NESTOR (DC)
Entity type:Individual
Prefix:
First Name:NESTOR
Middle Name:
Last Name:RIVAS
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 1:155 REPARTO MENDEZ
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-2863
Mailing Address - Country:US
Mailing Address - Phone:787-452-1758
Mailing Address - Fax:
Practice Address - Street 1:155 REPARTO MENDEZ
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627-2863
Practice Address - Country:US
Practice Address - Phone:787-452-1758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-22
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR744111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty