Provider Demographics
NPI:1740950484
Name:RIVERA, ZULMA ALEXANDRA
Entity type:Individual
Prefix:
First Name:ZULMA
Middle Name:ALEXANDRA
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 1:3514 W MALAPAI DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-1228
Mailing Address - Country:US
Mailing Address - Phone:623-230-9077
Mailing Address - Fax:
Practice Address - Street 1:15721 N GREENWAY HAYDEN LOOP STE 103
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1776
Practice Address - Country:US
Practice Address - Phone:602-362-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD08868340106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician