Provider Demographics
NPI:1306070404
Name:RIVERA GRACIA, LILIANA I (MSSLP)
Entity type:Individual
Prefix:
First Name:LILIANA
Middle Name:I
Last Name:RIVERA GRACIA
Suffix:
Gender:F
Credentials:MSSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE BRASIL B-27
Mailing Address - Street 2:URB GARDENVILLE
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966
Mailing Address - Country:UM
Mailing Address - Phone:787-782-9834
Mailing Address - Fax:787-982-0091
Practice Address - Street 1:CALLE BRASIL # B-27
Practice Address - Street 2:URB GARDENVILLE
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966
Practice Address - Country:US
Practice Address - Phone:787-782-9834
Practice Address - Fax:787-982-0091
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR843235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR843OtherLICENSE