Provider Demographics
NPI:1073263273
Name:DE JESUS RIVERA, NINOSHKA
Entity Type:Individual
Prefix:
First Name:NINOSHKA
Middle Name:
Last Name:DE JESUS 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 1:6900 SHARLANDS AVE UNIT 2126
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-2908
Mailing Address - Country:US
Mailing Address - Phone:860-861-6821
Mailing Address - Fax:
Practice Address - Street 1:6900 SHARLANDS AVE UNIT 2126
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-2908
Practice Address - Country:US
Practice Address - Phone:860-861-6821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program