Provider Demographics
NPI:1316159007
Name:RIVERA, CAMILLE (CNM)
Entity type:Individual
Prefix:MRS
First Name:CAMILLE
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC -01 BOX 25795
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-226-5840
Mailing Address - Fax:
Practice Address - Street 1:CARR.173 RAMAL 792
Practice Address - Street 2:BO. JAGUEYES
Practice Address - City:AGUAS BUENAS
Practice Address - State:PR
Practice Address - Zip Code:00703
Practice Address - Country:US
Practice Address - Phone:787-226-5840
Practice Address - Fax:787-281-7355
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1199367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife