Provider Demographics
NPI:1639727159
Name:RIVERO, DIANA MARIA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:MARIA
Last Name:RIVERO
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 1:960 N POINT PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-8892
Mailing Address - Country:US
Mailing Address - Phone:770-274-9511
Mailing Address - Fax:
Practice Address - Street 1:960 N POINT PKWY STE 120
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-8892
Practice Address - Country:US
Practice Address - Phone:770-274-9511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9467135163W00000X
GARN316942363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN316942OtherBOARD OF NURSING
FLRN9467135OtherDEPARTMENT OF HEALTH