Provider Demographics
NPI:1730458472
Name:RIVERA, ELSA
Entity Type:Individual
Prefix:
First Name:ELSA
Middle Name:
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 1:1027 E 9TH AVE
Mailing Address - Street 2:APT 101
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-1554
Mailing Address - Country:US
Mailing Address - Phone:303-718-3851
Mailing Address - Fax:
Practice Address - Street 1:5140 W 120TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80020-3307
Practice Address - Country:US
Practice Address - Phone:303-451-6706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12787225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist