Provider Demographics
NPI:1013666981
Name:RIVERA, DAVID JR
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:RIVERA
Suffix:JR
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 1:604 S BROOKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:ASH GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:65604-8908
Mailing Address - Country:US
Mailing Address - Phone:417-366-5006
Mailing Address - Fax:
Practice Address - Street 1:607 S BROOKSIDE AVE
Practice Address - Street 2:
Practice Address - City:ASH GROVE
Practice Address - State:MO
Practice Address - Zip Code:65604-8909
Practice Address - Country:US
Practice Address - Phone:417-366-5006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-19
Last Update Date:2022-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No332U00000XSuppliersHome Delivered Meals