Provider Demographics
NPI:1154048080
Name:RIVERA, NEYSHA M (MRC)
Entity type:Individual
Prefix:
First Name:NEYSHA
Middle Name:M
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MRC
Other - Prefix:
Other - First Name:NEYSHA
Other - Middle Name:M
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:81 CALLE MAYAGUEZ APT 315
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-5137
Mailing Address - Country:US
Mailing Address - Phone:787-949-8186
Mailing Address - Fax:
Practice Address - Street 1:81 CALLE MAYAGUEZ APT 315
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5137
Practice Address - Country:US
Practice Address - Phone:787-949-8186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1760225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorGroup - Single Specialty