Provider Demographics
NPI:1477035343
Name:RIVERA, LORENA DE GUIA
Entity Type:Individual
Prefix:MRS
First Name:LORENA
Middle Name:DE GUIA
Last Name: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 1:2424 WILCREST DR STE 110
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-2772
Mailing Address - Country:US
Mailing Address - Phone:713-666-8287
Mailing Address - Fax:713-660-8391
Practice Address - Street 1:5135 E PAGEWICK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77041-7856
Practice Address - Country:US
Practice Address - Phone:281-896-4153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX331564164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse