Provider Demographics
NPI:1922557479
Name:RIVERA, SONIA
Entity Type:Individual
Prefix:
First Name:SONIA
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 1:6525 NORTH AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1033
Mailing Address - Country:US
Mailing Address - Phone:708-445-0012
Mailing Address - Fax:
Practice Address - Street 1:6525 NORTH AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1033
Practice Address - Country:US
Practice Address - Phone:708-445-0012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198-000435171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist