Provider Demographics
NPI:1144993189
Name:RIVERA RIVERA, MARLA
Entity type:Individual
Prefix:
First Name:MARLA
Middle Name:
Last Name:RIVERA RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. BRISAS DE EVELYMAR
Mailing Address - Street 2:1005 CALLE CORAL
Mailing Address - City:SALINAS
Mailing Address - State:PR
Mailing Address - Zip Code:00751-1400
Mailing Address - Country:US
Mailing Address - Phone:787-486-7149
Mailing Address - Fax:
Practice Address - Street 1:CARR. PR-1 KM 77.9 BO.LAPA SECTOR PARCELAS
Practice Address - Street 2:VAZGUEZ #480
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751
Practice Address - Country:US
Practice Address - Phone:787-486-7149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7054103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical