MEDICARE: KIYA RIVERA RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	86043012	VA

General Provider Information

NPI Number	:	1326551128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIYA RIVERA RD

Provider Business Mailing Address
First Line	:	8200 MEADOWBRIDGE RD STE 305
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-2337
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8220 MEADOWBRIDGE RD STE 305
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-2339
Country	:	US
Telephone Number	:	804-287-4590
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2017
Last Update Date	:	11/15/2017

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