Basic Information
| Provider Information | |||||||||
| NPI: | 1285136564 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIVERA DIAZ | ||||||||
| FirstName: | MONICA | ||||||||
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| Credential: | PH.D.. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 702 | ||||||||
| Address2: | |||||||||
| City: | TOA ALTA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009540702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872385504 | ||||||||
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| Practice Location | |||||||||
| Address1: | 201 FLORAL VALE BLVD | ||||||||
| Address2: | |||||||||
| City: | YARDLEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190675524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4843518459 | ||||||||
| FaxNumber: | 4843518810 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2018 | ||||||||
| LastUpdateDate: | 03/02/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZE0600X | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Electroneurodiagnostic |
No ID Information.