Provider Demographics
NPI:1669231726
Name:RIVERA RODRIGUEZ, AIXA MARIA
Entity type:Individual
Prefix:
First Name:AIXA
Middle Name:MARIA
Last Name:RIVERA RODRIGUEZ
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 1:402 W GRACE ST
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4712
Mailing Address - Country:US
Mailing Address - Phone:352-344-6974
Mailing Address - Fax:
Practice Address - Street 1:402 W GRACE ST
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4712
Practice Address - Country:US
Practice Address - Phone:352-344-6974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program