Provider Demographics
NPI:1043910946
Name:AQUINO RIVERA, IVELISSE
Entity type:Individual
Prefix:MS
First Name:IVELISSE
Middle Name:
Last Name:AQUINO RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:IVELISSE
Other - Middle Name:
Other - Last Name:AQUINO RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:HC 6 BOX 6863
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00971-9600
Mailing Address - Country:US
Mailing Address - Phone:787-203-3617
Mailing Address - Fax:
Practice Address - Street 1:CALLE MAGA BO. MONACILLOS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925
Practice Address - Country:US
Practice Address - Phone:787-203-3617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5381104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker