Provider Demographics
NPI:1063145415
Name:RIVERA RUIZ, JONATHAN A (MS)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:A
Last Name:RIVERA RUIZ
Suffix:
Gender:M
Credentials:MS
Other - Prefix:MR
Other - First Name:JONATHAN
Other - Middle Name:A
Other - Last Name:RIVERA RUIZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:EDIFICIO MEDICO HERMANAS DAVILA
Mailing Address - Street 2:SUITE 208
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-201-4002
Mailing Address - Fax:
Practice Address - Street 1:EDIFICIO MEDICO HERMANAS DAVILA
Practice Address - Street 2:SUITE 208
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-201-4002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-04
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR007431103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling