Provider Demographics
NPI:1033360938
Name:RIVERA, MONICA M (CSFA)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:M
Last Name:RIVERA
Suffix:
Gender:F
Credentials:CSFA
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 941274
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32794-1274
Mailing Address - Country:US
Mailing Address - Phone:888-322-6432
Mailing Address - Fax:888-329-6432
Practice Address - Street 1:2591 CARRICKTON CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32824-4217
Practice Address - Country:US
Practice Address - Phone:703-304-3912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2019-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
165383OtherCSFA CERTIFICATION