Provider Demographics
NPI:1942936604
Name:ENCARNACION RIVERA, PEDRO LUIS
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:LUIS
Last Name:ENCARNACION RIVERA
Suffix:
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 1:4304 HAYES AVE
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-2348
Mailing Address - Country:US
Mailing Address - Phone:407-272-1285
Mailing Address - Fax:
Practice Address - Street 1:4304 HAYES AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-2348
Practice Address - Country:US
Practice Address - Phone:407-272-1285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator