Provider Demographics
NPI:1083936918
Name:RIVERA, XIOMARA DELSOCCORRO (PTA)
Entity Type:Individual
Prefix:
First Name:XIOMARA
Middle Name:DELSOCCORRO
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 CARPENTER ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-3044
Mailing Address - Country:US
Mailing Address - Phone:401-497-9263
Mailing Address - Fax:
Practice Address - Street 1:134 THURBERS AVE
Practice Address - Street 2:#220A
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905
Practice Address - Country:US
Practice Address - Phone:401-270-9991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00617174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist