Provider Demographics
NPI:1558538512
Name:RIVERA, ANA L
Entity Type:Individual
Prefix:MRS
First Name:ANA
Middle Name:L
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 1:1100 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-3582
Mailing Address - Country:US
Mailing Address - Phone:407-892-1256
Mailing Address - Fax:407-892-1928
Practice Address - Street 1:1100 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-3582
Practice Address - Country:US
Practice Address - Phone:407-892-1256
Practice Address - Fax:407-892-1928
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSU28393246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist