| Doctor Name: | MR. JUAN BAUTISTA RIVERA DE LEON |
| NPI Number: | 1114156882 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | L.N.D. |
| License Number: | 1385 |
| Business Practice Address: | San Isidro Calle Calixto Carrera #73 Sabana Grande, PR - 006372029 |
| Business Phone Number: | 7876430494 |
| Business Fax Number: | |
| Mailing Address: | Urb. San Isidro Calle Calixto Carrera, #73 SABANA GRANDE |
| State: | PR |
| Postal Code: | 006372029 |
| Phone Number: | 7876430494 |
| Fax Number: | |
| NPI Enumeration Date: | 07/02/2009 |
| NPI Last Update Date: | 07/02/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133NN1002X |
| License Number: | 1385 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | PR |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Nutritionist |
| Taxonomy Specialization: | Nutrition, Education |
| Taxonomy Definition: | |