Provider Demographics
NPI:1902179278
Name:RIVERA, RAINA (RD, LD/N)
Entity Type:Individual
Prefix:
First Name:RAINA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4229 NW 43RD ST APT F42
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-2508
Mailing Address - Country:US
Mailing Address - Phone:407-491-8057
Mailing Address - Fax:
Practice Address - Street 1:4229 NW 43RD ST APT F42
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-2508
Practice Address - Country:US
Practice Address - Phone:407-491-8057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-17
Last Update Date:2021-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND5850133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
1007292OtherCDR
FLND 5850OtherLD/N