Provider Demographics
NPI:1902792526
Name:GONZALEZ RIVERA, LIANETZA MARIE
Entity type:Individual
Prefix:
First Name:LIANETZA
Middle Name:MARIE
Last Name:GONZALEZ 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 1:202 CALLE CANDIDO PAGAN
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:PR
Mailing Address - Zip Code:00751-2585
Mailing Address - Country:US
Mailing Address - Phone:787-298-9079
Mailing Address - Fax:
Practice Address - Street 1:202 CALLE CANDIDO PAGAN
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751-2585
Practice Address - Country:US
Practice Address - Phone:787-298-9079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4629235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist