Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 2793 | PR |
Y | 103T00000X | Psychologist | 2793 | PR |
NPI | 1013123819 |
---|---|
Provider Name | Dr. Mercedes Rivera |
First Address | San Juan, PR 00923-3101 |
Second Address | San Juan, PR 00923-3101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 08/07/2007 |