Provider Demographics
NPI:1588261150
Name:RIVERA ROSADO, MORAIMA (BS)
Entity type:Individual
Prefix:
First Name:MORAIMA
Middle Name:
Last Name:RIVERA ROSADO
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:C-5 B-11
Mailing Address - Street 2:URB. RIBERAS DEL RIO
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-983-2644
Mailing Address - Fax:
Practice Address - Street 1:C-5 B-11
Practice Address - Street 2:URB. RIBERAS DEL RIO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-983-2644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist