Provider Demographics
NPI:1356851455
Name:RIERA, REGINA LYNN (CST)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:LYNN
Last Name:RIERA
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:LYNN
Other - Last Name:HALSEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CST
Mailing Address - Street 1:226 VAN HORN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEMENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-4016
Mailing Address - Country:US
Mailing Address - Phone:856-217-2905
Mailing Address - Fax:
Practice Address - Street 1:90 BRICK RD
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2177
Practice Address - Country:US
Practice Address - Phone:855-986-3044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant