Provider Demographics
NPI:1811664105
Name:RIVERA, CAROLINE ESPERANZA
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ESPERANZA
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 1:7228 ROYAL GUARD AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-1162
Mailing Address - Country:US
Mailing Address - Phone:702-544-8116
Mailing Address - Fax:
Practice Address - Street 1:5575 S DURANGO DR STE 102
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-1834
Practice Address - Country:US
Practice Address - Phone:702-789-6877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician