Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | PR | |
N | 101YP2500X | Professional Counselor |
NPI | 1003109588 |
---|---|
Provider Name | Julio A. Rivera |
First Address | Carolina, PR 00987-5135 |
Second Address | Carolina, PR 00987 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2011 |
Last Update Date | 20/08/2012 |