Provider Demographics
NPI:1356378814
Name:RIVERA RIVERA, OMAYRA (PHD)
Entity type:Individual
Prefix:DR
First Name:OMAYRA
Middle Name:
Last Name:RIVERA RIVERA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 SECT PITILLO
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-7303
Mailing Address - Country:US
Mailing Address - Phone:787-608-0433
Mailing Address - Fax:
Practice Address - Street 1:1666 CALLE PARANA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-3145
Practice Address - Country:US
Practice Address - Phone:787-608-0433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2290103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR002-2483Medicare ID - Type UnspecifiedMEDICARE
PR2740OtherHUMANA INSURANCE
PR002-2483Medicare ID - Type UnspecifiedMEDICARE
PRA298OtherFIRST MEDICAL
PR2737OtherREFORMA
PR2741OtherMMM
PR101140OtherCRUZ AZUL
PR219079OtherPREFERRED HEALTH