Provider Demographics
NPI:1982007183
Name:RIVERA-BUTLER, GLORIA
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:RIVERA-BUTLER
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 1:973 REV JAMES A POLITE AVE
Mailing Address - Street 2:2A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-3027
Mailing Address - Country:US
Mailing Address - Phone:718-681-1817
Mailing Address - Fax:917-423-0442
Practice Address - Street 1:973 REV JAMES A POLITE AVE
Practice Address - Street 2:UNIT 2A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-3027
Practice Address - Country:US
Practice Address - Phone:718-681-1817
Practice Address - Fax:917-423-0442
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion