Provider Demographics
NPI:1689380826
Name:RIVERA, SHANE AUSTIN (GENRAL CONTRACTOR)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:AUSTIN
Last Name:RIVERA
Suffix:
Gender:M
Credentials:GENRAL CONTRACTOR
Other - Prefix:
Other - First Name:SHANE
Other - Middle Name:AUSTIN
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SR REMODELING
Mailing Address - Street 1:6810 S STEELE ST
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-1839
Mailing Address - Country:US
Mailing Address - Phone:720-530-4122
Mailing Address - Fax:
Practice Address - Street 1:6810 S STEELE ST
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-1839
Practice Address - Country:US
Practice Address - Phone:172-053-0412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications