Provider Demographics
NPI:1265928477
Name:RIVERA, TARENA
Entity type:Individual
Prefix:
First Name:TARENA
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 1:41 DUCHESS PL
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-7930
Mailing Address - Country:US
Mailing Address - Phone:856-503-8633
Mailing Address - Fax:856-459-5191
Practice Address - Street 1:41 DUCHESS PL
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-7930
Practice Address - Country:US
Practice Address - Phone:856-503-8633
Practice Address - Fax:856-459-5191
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker