Basic Information
| Provider Information | |||||||||
| NPI: | 1922762384 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIVERA MORALES | ||||||||
| FirstName: | ONELL | ||||||||
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| Mailing Information | |||||||||
| Address1: | URB. ESTEVES | ||||||||
| Address2: | CALLE PAJUIL #1421 | ||||||||
| City: | AGUADILLA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00603 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | BO PUENTE SECTOR LA ALCANTARILLA | ||||||||
| Address2: | 309 | ||||||||
| City: | CAMUY | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7879153000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2021 | ||||||||
| LastUpdateDate: | 10/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2355S0801X | 7559 | PR | Y | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant |
ID Information
| ID | Type | State | Issuer | Description | 4787232 | 01 | PR | DRIVERS LICENSE | OTHER |