Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 1205 | PR |
N | 225XP0200X | Occupational Therapist - Pediatrics | 1205 | PR |
NPI | 1306231485 |
---|---|
Provider Name | Angelica Rivera |
First Address | Naranjito, PR 00719-9710 |
Second Address | Naranjito, PR 00719-9710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2015 |
Last Update Date | 14/07/2015 |