Provider Demographics
NPI:1992925069
Name:RIVERA-ROLDAN, MILCA YARINEE (OTL)
Entity type:Individual
Prefix:
First Name:MILCA
Middle Name:YARINEE
Last Name:RIVERA-ROLDAN
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 CALLE LILA
Mailing Address - Street 2:CIUDAD JARDIN
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-2208
Mailing Address - Country:US
Mailing Address - Phone:787-646-4904
Mailing Address - Fax:
Practice Address - Street 1:2DO. PISO
Practice Address - Street 2:CENTRO COMERCIAL LITHEDA
Practice Address - City:CUPEY BAJO
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-755-8905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00676225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist