Provider Demographics
NPI:1275204950
Name:RIVERA, LETICIA (CPHT)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 MATAMOROS ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78040-5069
Mailing Address - Country:US
Mailing Address - Phone:956-726-4512
Mailing Address - Fax:
Practice Address - Street 1:1219 MATAMOROS ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-5069
Practice Address - Country:US
Practice Address - Phone:956-726-4512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX128300183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician