1245452648 NPI number — IVETTE D. RIVERA RIOLLANO PSY D

Table of content: IVETTE D. RIVERA RIOLLANO PSY D (NPI 1245452648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245452648 NPI number — IVETTE D. RIVERA RIOLLANO PSY D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVERA RIOLLANO
Provider First Name:
IVETTE
Provider Middle Name:
D.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PSY D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RIVERA RIOLLANO
Provider Other First Name:
IVETTE
Provider Other Middle Name:
D.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSY D
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1245452648
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1974
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HATILLO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00659-1974
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-367-7279
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARR 2 KM 84.7
Provider Second Line Business Practice Location Address:
URB ALTURAS DE HATILLO ESQUINA JARDIN
Provider Business Practice Location Address City Name:
HATILLO
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-367-7279
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  1699 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1974 . This is a "PSICOLOGA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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