Provider Demographics
NPI:1629349725
Name:RIVERA, ORLANDO JR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:ORLANDO
Middle Name:
Last Name:RIVERA
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 ADRIEL CV
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-3395
Mailing Address - Country:US
Mailing Address - Phone:619-587-1694
Mailing Address - Fax:
Practice Address - Street 1:2401 SOUTH 31ST STREET BSWH ATTN: ANESTHESIA DEPT
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76508-5191
Practice Address - Country:US
Practice Address - Phone:254-724-3681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-20
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA773968367500000X
TXAP130716367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered