1427012103 NPI number — PROF. ADA NIVIA RIVERA PT

Table of content: PROF. ADA NIVIA RIVERA PT (NPI 1427012103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427012103 NPI number — PROF. ADA NIVIA RIVERA PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVERA
Provider First Name:
ADA
Provider Middle Name:
NIVIA
Provider Name Prefix Text:
PROF.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RIVERA
Provider Other First Name:
ADA
Provider Other Middle Name:
NIVIA
Provider Other Name Prefix Text:
PROF.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1427012103
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ROMANY GARDENS, #9 SANTA ROSA ST.,
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00926-5652
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-720-8882
Provider Business Mailing Address Fax Number:
787-720-8882

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1076 CALLE 17
Provider Second Line Business Practice Location Address:
VILLA NEVAREZ
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00927-5326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-720-8882
Provider Business Practice Location Address Fax Number:
787-720-8882
Provider Enumeration Date:
04/12/2006

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: 225100000X , with the licence number:  337 , 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)





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