Provider Demographics
NPI:1487859914
Name:RIVERA, REBECCA R
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:R
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 1:108 WILLIAMS WAY
Mailing Address - Street 2:
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-5168
Mailing Address - Country:US
Mailing Address - Phone:512-759-1781
Mailing Address - Fax:
Practice Address - Street 1:108 WILLIAMS WAY
Practice Address - Street 2:
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634-5168
Practice Address - Country:US
Practice Address - Phone:512-759-1781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS11370171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator