Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor | 1601 | PR |
NPI | 1225486459 |
---|---|
Provider Name | Jonathan Rivera Aviles |
First Address | Manati, PR 00674-9818 |
Second Address | Manati, PR 00674-9818 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2016 |
Last Update Date | 27/05/2016 |