Provider Demographics
NPI:1932335593
Name:RIVERA, NYDIA E
Entity Type:Individual
Prefix:
First Name:NYDIA
Middle Name:E
Last Name: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 1:2250 AVE LAS AMERICAS STE 531
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-0655
Mailing Address - Country:US
Mailing Address - Phone:787-240-1503
Mailing Address - Fax:
Practice Address - Street 1:2250 AVE LAS AMERICAS STE 531
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0655
Practice Address - Country:US
Practice Address - Phone:787-240-1503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3345103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst