Provider Demographics
NPI:1639726920
Name:RIBERA HEALTHCARE
Entity Type:Organization
Organization Name:RIBERA HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCERO
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:505-450-4478
Mailing Address - Street 1:801 ENCINO PL NE STE D7
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2644
Mailing Address - Country:US
Mailing Address - Phone:505-207-6526
Mailing Address - Fax:505-212-1615
Practice Address - Street 1:801 ENCINO PL. NE
Practice Address - Street 2:SUITE D-7
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2644
Practice Address - Country:US
Practice Address - Phone:505-207-6526
Practice Address - Fax:505-212-1615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-21
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty