Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TC1900X | Counseling Psychologist | 2589 | PR |
Y | 208D00000X | General Practice Physician | 11264 | PR |
NPI | 1073733127 |
---|---|
Provider Name | Dr. Iksen Rivera-Morales |
First Address | Bayamon, PR 00958-1291 |
Second Address | San Juan, PR 00920-2717 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2007 |
Last Update Date | 19/02/2014 |