Provider Demographics
NPI:1811745573
Name:RIVERA RODRIGUEZ, KARLA BRISEIDA
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:BRISEIDA
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 1:1149 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-3515
Mailing Address - Country:US
Mailing Address - Phone:253-428-8431
Mailing Address - Fax:
Practice Address - Street 1:1149 MARKET ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-3515
Practice Address - Country:US
Practice Address - Phone:253-428-8431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator