Provider Demographics
NPI:1710226030
Name:RIVERA, MARIA DE JESUS
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:DE JESUS
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 1:7601 REINDEER RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-5643
Mailing Address - Country:US
Mailing Address - Phone:813-900-4472
Mailing Address - Fax:813-612-9258
Practice Address - Street 1:7601 REINDEER RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-5643
Practice Address - Country:US
Practice Address - Phone:813-900-4472
Practice Address - Fax:813-612-9258
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter