Provider Demographics
NPI:1518567551
Name:RIVERA, SANDRA IVETTE SR (BA EDUCATION)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:IVETTE
Last Name:RIVERA
Suffix:SR
Gender:F
Credentials:BA EDUCATION
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:I
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7315 KAHA ST UNIT 344
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-5684
Mailing Address - Country:US
Mailing Address - Phone:321-347-0311
Mailing Address - Fax:
Practice Address - Street 1:7315 KAHA ST UNIT 344
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-5684
Practice Address - Country:US
Practice Address - Phone:321-347-0311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management