Provider Demographics
NPI:1104559665
Name:RIVERA ROSA, HARRY G
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:G
Last Name:RIVERA ROSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 6697
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-9767
Mailing Address - Country:US
Mailing Address - Phone:939-257-0086
Mailing Address - Fax:
Practice Address - Street 1:8000 AVE JESUS T PINERO STE 119
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-5578
Practice Address - Country:US
Practice Address - Phone:939-257-0086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-02
Last Update Date:2022-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR160491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical