Provider Demographics
NPI:1174395909
Name:ROMAN RIVERA, NATHALIE E (DC)
Entity type:Individual
Prefix:DR
First Name:NATHALIE
Middle Name:E
Last Name:ROMAN RIVERA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CALLE RIQUEZA
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-7062
Mailing Address - Country:US
Mailing Address - Phone:404-988-0420
Mailing Address - Fax:
Practice Address - Street 1:295 PALMAS INN WAY, STE 125
Practice Address - Street 2:PALMANOVA PLAZA, PALMAS DEL MAR
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:404-988-0420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-25
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR952111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Multi-Specialty