Provider Demographics
NPI:1861799348
Name:RIVERA-GONZALEZ, SHEILA ISABEL (MS)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:ISABEL
Last Name:RIVERA-GONZALEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 5 BOX 91525
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-9517
Mailing Address - Country:US
Mailing Address - Phone:787-450-2329
Mailing Address - Fax:
Practice Address - Street 1:27-16 AVE ROBERTO CLEMENTE
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-5420
Practice Address - Country:US
Practice Address - Phone:787-276-8123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-18
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR911235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR04266850013OtherNUMERO DE REGISTRO DE COMERCIANTE