Provider Demographics
NPI:1528958659
Name:ORTEGA RIVERA, FAVIOLLA PAULLETTE
Entity type:Individual
Prefix:
First Name:FAVIOLLA
Middle Name:PAULLETTE
Last Name:ORTEGA 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:PO BOX 1561
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-1561
Mailing Address - Country:US
Mailing Address - Phone:787-818-0100
Mailing Address - Fax:
Practice Address - Street 1:PARQUE INDUSTRIAL DEL OESTE #29 CALLE ROCHELAISE
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682
Practice Address - Country:US
Practice Address - Phone:787-818-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-09
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4699235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist