Provider Demographics
NPI:1083331128
Name:RIVERA DAVILA, LIZMARY
Entity type:Individual
Prefix:DR
First Name:LIZMARY
Middle Name:
Last Name:RIVERA DAVILA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 436
Mailing Address - Street 2:
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769-0436
Mailing Address - Country:US
Mailing Address - Phone:787-803-3604
Mailing Address - Fax:
Practice Address - Street 1:49 CALLE BALDORIOTY
Practice Address - Street 2:
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769-3122
Practice Address - Country:US
Practice Address - Phone:787-803-3604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-19
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14273111N00000X
PR988111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor