Basic Information
| Provider Information | |||||||||
| NPI: | 1750842316 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIVERA | ||||||||
| FirstName: | HECTOR | ||||||||
| MiddleName: | LUIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 609 | ||||||||
| Address2: | |||||||||
| City: | CIDRA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007390609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7879406309 | ||||||||
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| Practice Location | |||||||||
| Address1: | CALLE SARGENTO GERARDO SANTIAGO CARR 14 INT 15 | ||||||||
| Address2: | |||||||||
| City: | AIBONITO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877142462 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2019 | ||||||||
| LastUpdateDate: | 03/27/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 23664 | PR | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.