Provider Demographics
NPI:1801256219
Name:CANDELARIA RIVERA, JALEYSHA MARIE
Entity type:Individual
Prefix:MISS
First Name:JALEYSHA
Middle Name:MARIE
Last Name:CANDELARIA 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:PO BOX 143805
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-3805
Mailing Address - Country:US
Mailing Address - Phone:939-246-9346
Mailing Address - Fax:
Practice Address - Street 1:63 CALLE TENIENTE LUIS GARCIA
Practice Address - Street 2:ARECIBO GARDENS
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-0000
Practice Address - Country:US
Practice Address - Phone:939-246-9346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001118224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant