Provider Demographics
NPI:1730323973
Name:RIVERA, VICROR JR
Entity Type:Individual
Prefix:
First Name:VICROR
Middle Name:
Last Name:RIVERA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 N MAIN UNIT 1 - 173
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-1154
Mailing Address - Country:US
Mailing Address - Phone:575-571-3595
Mailing Address - Fax:
Practice Address - Street 1:2530 S TELSHOR BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4907
Practice Address - Country:US
Practice Address - Phone:575-571-3595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Single Specialty