Provider Demographics
NPI:1548856776
Name:RIVERA CORDERO, SAIMYLIZ (RDN, LND)
Entity type:Individual
Prefix:
First Name:SAIMYLIZ
Middle Name:
Last Name:RIVERA CORDERO
Suffix:
Gender:F
Credentials:RDN, LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 CALLE CASTANER
Mailing Address - Street 2:HACIENDA ISABEL
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757-3008
Mailing Address - Country:US
Mailing Address - Phone:787-322-8561
Mailing Address - Fax:
Practice Address - Street 1:CARR 173 KM 6.5 LOCAL B
Practice Address - Street 2:BO RABANAL
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:787-322-8561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR86150603133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered