Provider Demographics
NPI:1043782899
Name:RIVRA, BRICE
Entity Type:Individual
Prefix:
First Name:BRICE
Middle Name:
Last Name:RIVRA
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:RR 612 LOOP ROAD
Mailing Address - Street 2:
Mailing Address - City:JACSKSONVILE
Mailing Address - State:NC
Mailing Address - Zip Code:28540
Mailing Address - Country:US
Mailing Address - Phone:910-440-1942
Mailing Address - Fax:
Practice Address - Street 1:RR 612 LOOP ROAD
Practice Address - Street 2:
Practice Address - City:JACSKSONVILE
Practice Address - State:NC
Practice Address - Zip Code:28540
Practice Address - Country:US
Practice Address - Phone:910-440-1942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman