Provider Demographics
NPI:1720851322
Name:RIVERA-MALDONADO, DIANA ALICIA (MASSAGE THERPIST)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:ALICIA
Last Name:RIVERA-MALDONADO
Suffix:
Gender:F
Credentials:MASSAGE THERPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7135 W TIDWELL RD # M104
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-2057
Mailing Address - Country:US
Mailing Address - Phone:281-330-5562
Mailing Address - Fax:
Practice Address - Street 1:7135 W TIDWELL RD # M104
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-2057
Practice Address - Country:US
Practice Address - Phone:281-330-5562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT018174225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty