Provider Demographics
NPI:1124303763
Name:RIVERA, RAMON LUIS
Entity type:Individual
Prefix:MR
First Name:RAMON
Middle Name:LUIS
Last Name:RIVERA
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:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:BARCELONETA
Mailing Address - State:PR
Mailing Address - Zip Code:00617-0054
Mailing Address - Country:US
Mailing Address - Phone:787-995-5200
Mailing Address - Fax:787-995-5189
Practice Address - Street 1:PLAZA LAUREL
Practice Address - Street 2:#100
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-3273
Practice Address - Country:US
Practice Address - Phone:787-995-5200
Practice Address - Fax:787-995-5189
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19421104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker