Provider Demographics
NPI:1265326185
Name:RIVERA, JUAN AUSBERTO
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:AUSBERTO
Last Name:RIVERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB SAN ANTONIO
Mailing Address - Street 2:CALLE 2A #5A
Mailing Address - City:AGUAS BUENAS
Mailing Address - State:PR
Mailing Address - Zip Code:00703
Mailing Address - Country:US
Mailing Address - Phone:787-340-3389
Mailing Address - Fax:
Practice Address - Street 1:AVE VELAZQUEZ #34
Practice Address - Street 2:P-4, SUITE NUM. 2 TERCER NIVEL, RESTAURANTE LOS GORDITO
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00745
Practice Address - Country:US
Practice Address - Phone:787-680-7523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4036103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist