Basic Information
Provider Information
NPI: 1003003914
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RIVERA LLUVERAS
FirstName: KENIA
MiddleName: MARI
NamePrefix: DR.
NameSuffix:  
Credential: PSY.D
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: CALLE 9 NUM. I 13 VISTA BELLA
Address2:  
City: BAYAMON
State: PUERTO RICO
PostalCode: 00956 4838
CountryCode: UM
TelephoneNumber: 7875982415
FaxNumber:  
Practice Location
Address1: CARR. 21 S3 LAS LOMAS BO. MONACILLOS
Address2: OFFICE # 2
City: SAN JUAN
State: PR
PostalCode: 00956
CountryCode: US
TelephoneNumber: 7875982415
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/25/2007
LastUpdateDate: 09/25/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC0700X2792PRY Behavioral Health & Social Service ProvidersPsychologistClinical

No ID Information.


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